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This is VAERS ID 383724

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 383724
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 5/11/2010

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 8/31/2010

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 4/13/2011

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Agitation, Anuria, Blood calcium increased, C-reactive protein increased, Candida nappy rash, Carbon dioxide decreased, Cough, Crying, Dehydration, Diarrhoea, Eczema, Flushing, Gastroenteritis, Gastroenteritis viral, Haematochezia, Hypersomnia, Intussusception, Laryngitis, Lethargy, Malaise, Nasopharyngitis, Neutrophil count increased, Otitis media, Platelet morphology abnormal, Rash papular, Rhinorrhoea, Somnolence, Surgery, Upper respiratory tract infection, Urine abnormality, Vomiting, Vomiting projectile, Wheezing, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Monocyte percentage increased, Upper respiratory tract congestion, Protein urine present, Red cell distribution width increased, Urine ketone body present, Band neutrophil percentage increased, Urine ketone body, Urine output decreased, Decreased appetite, Grimacing

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 5/13/2011

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Agitation, Anuria, Blood calcium increased, C-reactive protein increased, Candida nappy rash, Carbon dioxide decreased, Cough, Crying, Dehydration, Diarrhoea, Eczema, Flushing, Gastroenteritis, Gastroenteritis viral, Haematochezia, Hypersomnia, Intussusception, Laryngitis, Lethargy, Malaise, Nasopharyngitis, Neutrophil count increased, Otitis media, Platelet morphology abnormal, Rash papular, Rhinorrhoea, Somnolence, Surgery, Upper respiratory tract infection, Urine abnormality, Vomiting, Vomiting projectile, Wheezing, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Monocyte percentage increased, Upper respiratory tract congestion, Protein urine present, Red cell distribution width increased, Urine ketone body present, Band neutrophil percentage increased, Urine ketone body, Urine output decreased, Decreased appetite, Grimacing

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 6/11/2011

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Agitation, Anuria, Blood calcium increased, C-reactive protein increased, Candida nappy rash, Carbon dioxide decreased, Cough, Crying, Dehydration, Diarrhoea, Eczema, Flushing, Gastroenteritis, Gastroenteritis viral, Haematochezia, Hypersomnia, Intussusception, Laryngitis, Lethargy, Malaise, Nasopharyngitis, Neutrophil count increased, Otitis media, Platelet morphology abnormal, Rash papular, Rhinorrhoea, Somnolence, Surgery, Upper respiratory tract infection, Urine abnormality, Vomiting, Vomiting projectile, Wheezing, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Monocyte percentage increased, Upper respiratory tract congestion, Protein urine present, Red cell distribution width increased, Urine ketone body present, Band neutrophil percentage increased, Urine ketone body, Urine output decreased, Decreased appetite, Grimacing

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 5/13/2013

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Agitation, Anuria, Blood calcium increased, C-reactive protein increased, Candida nappy rash, Carbon dioxide decreased, Cough, Crying, Dehydration, Diarrhoea, Eczema, Flushing, Gastroenteritis, Gastroenteritis viral, Haematochezia, Hypersomnia, Intussusception, Laryngitis, Lethargy, Malaise, Nasopharyngitis, Neutrophil count increased, Otitis media, Platelet morphology abnormal, Rash papular, Rhinorrhoea, Somnolence, Surgery, Upper respiratory tract infection, Urine abnormality, Vomiting, Vomiting projectile, Wheezing, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Monocyte percentage increased, Upper respiratory tract congestion, Protein urine present, Red cell distribution width increased, Urine ketone body present, Band neutrophil percentage increased, Urine ketone body, Urine output decreased, Decreased appetite, Grimacing

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 6/14/2014

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Agitation, Anuria, Blood calcium increased, C-reactive protein increased, Candida nappy rash, Carbon dioxide decreased, Cough, Crying, Dehydration, Diarrhoea, Eczema, Flushing, Gastroenteritis, Gastroenteritis viral, Haematochezia, Hypersomnia, Intussusception, Laryngitis, Lethargy, Malaise, Nasopharyngitis, Neutrophil count increased, Otitis media, Platelet morphology abnormal, Rash papular, Rhinorrhoea, Somnolence, Surgery, Upper respiratory tract infection, Urine abnormality, Vomiting, Vomiting projectile, Wheezing, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Monocyte percentage increased, Upper respiratory tract congestion, Protein urine present, Red cell distribution width increased, Urine ketone body present, Band neutrophil percentage increased, Urine ketone body, Urine output decreased, Decreased appetite, Grimacing

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 3/14/2015

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Agitation, Anuria, Blood calcium increased, C-reactive protein increased, Candida nappy rash, Carbon dioxide decreased, Cough, Crying, Dehydration, Diarrhoea, Eczema, Flushing, Gastroenteritis, Gastroenteritis viral, Haematochezia, Hypersomnia, Intussusception, Laryngitis, Lethargy, Malaise, Nasopharyngitis, Neutrophil count increased, Otitis media, Platelet morphology abnormal, Rash papular, Rhinorrhoea, Somnolence, Surgery, Upper respiratory tract infection, Urine abnormality, Vomiting, Vomiting projectile, Wheezing, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Monocyte percentage increased, Upper respiratory tract congestion, Protein urine present, Red cell distribution width increased, Urine ketone body present, Band neutrophil percentage increased, Urine ketone body, Urine output decreased, Decreased appetite, Grimacing

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

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 2/14/2017

VAERS ID: 383724 Before After
VAERS Form:
Age:0.5 0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

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

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 4/14/2017

VAERS ID: 383724 Before After
VAERS Form:
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 9/14/2017

VAERS ID: 383724 Before After
VAERS Form:(blank) 1
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 2/14/2018

VAERS ID: 383724 Before After
VAERS Form:1
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 6/14/2018

VAERS ID: 383724 Before After
VAERS Form:1
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 8/14/2018

VAERS ID: 383724 Before After
VAERS Form:1
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 9/14/2018

VAERS ID: 383724 Before After
VAERS Form:1
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


Changed on 10/14/2018

VAERS ID: 383724 Before After
VAERS Form:1
Age:0.52
Sex:Male
Location:Maryland
Vaccinated:2009-09-01
Onset:2009-12-09
Submitted:2010-03-24
Entered:2010-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=383724&WAYBACKHISTORY=ON


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