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This is VAERS ID 379548

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 379548
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74804 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 3/2/2010

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D74804 / 0 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 0 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 3 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 4/7/2010

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 7/31/2010

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 8/31/2010

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 1/4/2011

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 4/13/2011

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 5/13/2011

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 6/11/2011

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 5/13/2013

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 6/14/2014

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 3/14/2015

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Barium enema abnormal, Blood culture negative, Blood glucose increased, Chest X-ray abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Laparotomy, Nausea, Red blood cell count decreased, Surgery, Vomiting, White blood cell count increased, X-ray normal, Ultrasound abdomen abnormal, Liver function test normal, Metabolic function test

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 2/14/2017

VAERS ID: 379548 Before After
VAERS Form:
Age:0.2 0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 4/14/2017

VAERS ID: 379548 Before After
VAERS Form:
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 9/14/2017

VAERS ID: 379548 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 2/14/2018

VAERS ID: 379548 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 6/14/2018

VAERS ID: 379548 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 8/14/2018

VAERS ID: 379548 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 9/14/2018

VAERS ID: 379548 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


Changed on 10/14/2018

VAERS ID: 379548 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Arizona
Vaccinated:2010-01-21
Onset:2010-01-27
Submitted:2010-01-30
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC 'Split Type':

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.

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