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This is VAERS ID 382920

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 382920
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum


Changed on 5/11/2010

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum


Changed on 8/31/2010

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum


Changed on 4/13/2011

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, C-reactive protein normal, Crying, Culture stool negative, Full blood count, Haematochezia, Intussusception, Vomiting, X-ray abnormal, Explorative laparotomy

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum


Changed on 5/13/2011

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, C-reactive protein normal, Crying, Culture stool negative, Full blood count, Haematochezia, Intussusception, Vomiting, X-ray abnormal, Explorative laparotomy

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum


Changed on 6/11/2011

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, C-reactive protein normal, Crying, Culture stool negative, Full blood count, Haematochezia, Intussusception, Vomiting, X-ray abnormal, Explorative laparotomy

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum


Changed on 2/13/2013

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, C-reactive protein normal, Crying, Culture stool negative, Full blood count, Haematochezia, Intussusception, Vomiting, X-ray abnormal, Explorative laparotomy

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: double intussusceptum Double intussusceptum.


Changed on 5/13/2013

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, C-reactive protein normal, Crying, Culture stool negative, Full blood count, Haematochezia, Intussusception, Vomiting, X-ray abnormal, Explorative laparotomy

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 3/14/2015

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, C-reactive protein normal, Crying, Culture stool negative, Full blood count, Haematochezia, Intussusception, Vomiting, X-ray abnormal, Explorative laparotomy

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 2/14/2017

VAERS ID: 382920 Before After
VAERS Form:
Age:0.2 0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 9/14/2017

VAERS ID: 382920 Before After
VAERS Form:(blank) 1
Age:0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 2/14/2018

VAERS ID: 382920 Before After
VAERS Form:1
Age:0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 6/14/2018

VAERS ID: 382920 Before After
VAERS Form:1
Age:0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 8/14/2018

VAERS ID: 382920 Before After
VAERS Form:1
Age:0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 9/14/2018

VAERS ID: 382920 Before After
VAERS Form:1
Age:0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.


Changed on 10/14/2018

VAERS ID: 382920 Before After
VAERS Form:1
Age:0.24
Sex:Female
Location:Michigan
Vaccinated:2010-03-11
Onset:2010-03-14
Submitted:2010-03-18
Entered:2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Double intussusceptum.

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