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This is VAERS ID 385949

History of Changes from the VAERS Wayback Machine

First Appeared on 5/11/2010

VAERS ID: 385949
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 8/31/2010

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound scan

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 1/4/2011

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound scan

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 4/13/2011

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood creatinine decreased, Haematochezia, Intussusception, Monocyte count increased, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 5/13/2011

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood creatinine decreased, Haematochezia, Intussusception, Monocyte count increased, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 6/11/2011

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood creatinine decreased, Haematochezia, Intussusception, Monocyte count increased, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 5/13/2013

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood creatinine decreased, Haematochezia, Intussusception, Monocyte count increased, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 6/14/2014

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood creatinine decreased, Haematochezia, Intussusception, Monocyte count increased, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 3/14/2015

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood creatinine decreased, Haematochezia, Intussusception, Monocyte count increased, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 2/14/2017

VAERS ID: 385949 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 4/14/2017

VAERS ID: 385949 Before After
VAERS Form:
Age:0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 9/14/2017

VAERS ID: 385949 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 0 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 1 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 0 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 2/14/2018

VAERS ID: 385949 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 6/14/2018

VAERS ID: 385949 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 8/14/2018

VAERS ID: 385949 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.


Changed on 9/14/2018

VAERS ID: 385949 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Nebraska
Vaccinated:2010-03-01
Onset:2010-04-24
Submitted:2010-04-26
Entered:2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB772CA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E20366 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB036A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC 'Split Type':

Write-up: Infant was admitted to hospital with intussusception on 4/24/10.

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