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This is VAERS ID 380180

History of Changes from the VAERS Wayback Machine

First Appeared on 3/2/2010

380180
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Vomiting, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 4/7/2010

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Vomiting, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 8/31/2010

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Ultrasound scan, Vomiting, Exploratory operation, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 1/4/2011

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Ultrasound scan, Vomiting, Exploratory operation, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 4/13/2011

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 5/13/2011

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 6/11/2011

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 5/13/2013

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 6/14/2014

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 3/14/2015

380180 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 2/14/2017

380180 Before After
VAERS Form:
Age:0.4 0.44
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Vomiting, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 4/14/2017

380180 Before After
VAERS Form:
Age:0.44
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Vomiting, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


Changed on 9/14/2017

380180 Before After
VAERS Form:(blank) 1
Age:0.44
Gender:Male
Location:Arkansas
Vaccinated:2009-08-19
Onset:2009-09-18
Submitted:0000-00-00
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Dehydration, Intussusception, Vomiting, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC 'Split Type':

Write-up:Vomiting-$gdehydration-$gintussusception.


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