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This is VAERS ID 273125

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273125
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE915AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and d"iagnosed with intussusception of the intestines


Changed on 12/8/2009

VAERS ID: 273125 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE915AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and d"iagnosed diagnosed with intussusception of the intestines


Changed on 3/2/2010

VAERS ID: 273125 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE915AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08672F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 4/7/2010

VAERS ID: 273125 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE915AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 5/13/2013

VAERS ID: 273125 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE915AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 5/14/2017

VAERS ID: 273125 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE915AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08672F / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 9/14/2017

VAERS ID: 273125 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE915AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 2/14/2018

VAERS ID: 273125 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE915AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 6/14/2018

VAERS ID: 273125 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE915AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 8/14/2018

VAERS ID: 273125 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE915AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


Changed on 9/14/2018

VAERS ID: 273125 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:New York
Vaccinated:2007-01-17
Onset:2007-02-20
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE915AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines

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