National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 384610

History of Changes from the VAERS Wayback Machine

First Appeared on 5/11/2010

VAERS ID: 384610
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 8/31/2010

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 4/13/2011

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Condition aggravated, Culture stool negative, Diarrhoea, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Lethargy, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Intestinal resection, Stool analysis abnormal, Colectomy, Occult blood positive

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 5/13/2011

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Condition aggravated, Culture stool negative, Diarrhoea, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Lethargy, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Intestinal resection, Stool analysis abnormal, Colectomy, Occult blood positive

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 6/11/2011

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Condition aggravated, Culture stool negative, Diarrhoea, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Lethargy, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Intestinal resection, Stool analysis abnormal, Colectomy, Occult blood positive

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 5/13/2013

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Condition aggravated, Culture stool negative, Diarrhoea, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Lethargy, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Intestinal resection, Stool analysis abnormal, Colectomy, Occult blood positive

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 3/14/2015

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Condition aggravated, Culture stool negative, Diarrhoea, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Lethargy, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Intestinal resection, Stool analysis abnormal, Colectomy, Occult blood positive

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 2/14/2017

VAERS ID: 384610 Before After
VAERS Form:
Age:0.2 0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 9/14/2017

VAERS ID: 384610 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 2/14/2018

VAERS ID: 384610 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 6/14/2018

VAERS ID: 384610 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 8/14/2018

VAERS ID: 384610 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 9/14/2018

VAERS ID: 384610 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


Changed on 10/14/2018

VAERS ID: 384610 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Oklahoma
Vaccinated:2010-03-29
Onset:2010-04-03
Submitted:2010-04-08
Entered:2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Intussusception, Lethargy, Vomiting, Intestinal resection

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC 'Split Type':

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=384610&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166