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This is VAERS ID 380464

History of Changes from the VAERS Wayback Machine

First Appeared on 3/2/2010

VAERS ID: 380464
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 4/7/2010

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 7/31/2010

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 8/31/2010

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 4/13/2011

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 5/13/2011

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 6/11/2011

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 5/13/2013

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 3/14/2015

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 2/14/2017

VAERS ID: 380464 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 9/14/2017

VAERS ID: 380464 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 2/14/2018

VAERS ID: 380464 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 6/14/2018

VAERS ID: 380464 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 8/14/2018

VAERS ID: 380464 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 9/14/2018

VAERS ID: 380464 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


Changed on 10/14/2018

VAERS ID: 380464 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2010-01-18
Onset:2010-01-19
Submitted:0000-00-00
Entered:2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC 'Split Type':

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.

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