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This is VAERS ID 382236

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 382236
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 8/31/2010

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal perforation, Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 1/4/2011

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal perforation, Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 4/13/2011

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Colostomy, Dehydration, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Lethargy, Nasopharyngitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Colectomy, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 5/13/2011

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Colostomy, Dehydration, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Lethargy, Nasopharyngitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Colectomy, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 6/11/2011

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Colostomy, Dehydration, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Lethargy, Nasopharyngitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Colectomy, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 5/13/2013

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Colostomy, Dehydration, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Lethargy, Nasopharyngitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Colectomy, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 3/14/2015

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Colostomy, Dehydration, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Lethargy, Nasopharyngitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Colectomy, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 2/14/2017

VAERS ID: 382236 Before After
VAERS Form:
Age:0.4 0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 9/14/2017

VAERS ID: 382236 Before After
VAERS Form:(blank) 1
Age:0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 2/14/2018

VAERS ID: 382236 Before After
VAERS Form:1
Age:0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 6/14/2018

VAERS ID: 382236 Before After
VAERS Form:1
Age:0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 8/14/2018

VAERS ID: 382236 Before After
VAERS Form:1
Age:0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 9/14/2018

VAERS ID: 382236 Before After
VAERS Form:1
Age:0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


Changed on 10/14/2018

VAERS ID: 382236 Before After
VAERS Form:1
Age:0.42
Sex:Female
Location:Unknown
Vaccinated:2010-03-02
Onset:2010-03-05
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Vomiting, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC 'Split Type':

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010

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