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This is VAERS ID 303464

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 303464
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinati"ons administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether me


Changed on 12/8/2009

VAERS ID: 303464 Before After
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinati"ons vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether me medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested.


Changed on 2/5/2010

VAERS ID: 303464 Before After
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


Changed on 3/2/2010

VAERS ID: 303464 Before After
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


Changed on 4/7/2010

VAERS ID: 303464 Before After
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


Changed on 8/31/2010

VAERS ID: 303464 Before After
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


Changed on 5/13/2013

VAERS ID: 303464 Before After
VAERS Form:
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 303464 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 4 - MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 303464 Before After
VAERS Form:1
Age:0.5
Gender:Unknown
Location:Michigan
Vaccinated:2007-10-29
Onset:2007-10-29
Submitted:2008-01-15
Entered:2008-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Viral rash, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


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