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This is VAERS ID 269344

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 269344
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Y0991 / 1 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08681F / 1 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 12/8/2009

VAERS ID: 269344 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08681F / 1 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 3/2/2010

VAERS ID: 269344 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08681F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 4/7/2010

VAERS ID: 269344 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08681F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 5/13/2013

VAERS ID: 269344 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08681F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 2/14/2017

VAERS ID: 269344 Before After
VAERS Form:
Age:0.4 0.35
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08681F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 9/14/2017

VAERS ID: 269344 Before After
VAERS Form:(blank) 1
Age:0.35
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681F / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 2/14/2018

VAERS ID: 269344 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


Changed on 6/14/2018

VAERS ID: 269344 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:California
Vaccinated:2006-11-02
Onset:2006-12-08
Submitted:2006-12-15
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269344&WAYBACKHISTORY=ON


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