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This is VAERS ID 383135

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

383135
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D94434 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:intussusception


Changed on 8/31/2010

383135 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D94434 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:intussusception


Changed on 4/13/2011

383135 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Aspartate aminotransferase increased, Barium double contrast, Blood creatinine decreased, Blood culture negative, Carbon dioxide decreased, Culture stool negative, Diarrhoea, Full blood count, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Red blood cell count decreased, Vomiting, Platelet count increased, Stool analysis abnormal, Metabolic function test

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

Write-up:intussusception


Changed on 5/13/2011

383135 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Aspartate aminotransferase increased, Barium double contrast, Blood creatinine decreased, Blood culture negative, Carbon dioxide decreased, Culture stool negative, Diarrhoea, Full blood count, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Red blood cell count decreased, Vomiting, Platelet count increased, Stool analysis abnormal, Metabolic function test

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

Write-up:intussusception


Changed on 6/11/2011

383135 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Aspartate aminotransferase increased, Barium double contrast, Blood creatinine decreased, Blood culture negative, Carbon dioxide decreased, Culture stool negative, Diarrhoea, Full blood count, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Red blood cell count decreased, Vomiting, Platelet count increased, Stool analysis abnormal, Metabolic function test

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

Write-up:intussusception


Changed on 5/13/2013

383135 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Aspartate aminotransferase increased, Barium double contrast, Blood creatinine decreased, Blood culture negative, Carbon dioxide decreased, Culture stool negative, Diarrhoea, Full blood count, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Red blood cell count decreased, Vomiting, Platelet count increased, Stool analysis abnormal, Metabolic function test

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

Write-up:intussusception


Changed on 3/14/2015

383135 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Aspartate aminotransferase increased, Barium double contrast, Blood creatinine decreased, Blood culture negative, Carbon dioxide decreased, Culture stool negative, Diarrhoea, Full blood count, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Red blood cell count decreased, Vomiting, Platelet count increased, Stool analysis abnormal, Metabolic function test

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

Write-up:intussusception


Changed on 2/14/2017

383135 Before After
VAERS Form:
Age:0.5 0.52
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 - / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:intussusception


Changed on 9/14/2017

383135 Before After
VAERS Form:(blank) 1
Age:0.52
Gender:Male
Location:New York
Vaccinated:2010-03-15
Onset:2010-03-19
Submitted:2010-03-22
Entered:2010-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3555AA / 1 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVB818BA / 3 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94434 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB036A / 1 2 - MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:intussusception


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