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This is VAERS ID 386671

History of Changes from the VAERS Wayback Machine

First Appeared on 5/11/2010

VAERS ID: 386671
VAERS Form:
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 2 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E45349 / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 8/31/2010

VAERS ID: 386671 Before After
VAERS Form:
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 2 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH E45349 / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 5/13/2013

VAERS ID: 386671 Before After
VAERS Form:
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 2 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 9/14/2017

VAERS ID: 386671 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 2 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 2 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 2 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 2 3 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 2/14/2018

VAERS ID: 386671 Before After
VAERS Form:1
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 6/14/2018

VAERS ID: 386671 Before After
VAERS Form:1
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 8/14/2018

VAERS ID: 386671 Before After
VAERS Form:1
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 9/14/2018

VAERS ID: 386671 Before After
VAERS Form:1
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


Changed on 10/14/2018

VAERS ID: 386671 Before After
VAERS Form:1
Age:
Sex:Male
Location:Washington
Vaccinated:2010-04-14
Onset:2010-04-28
Submitted:2010-05-04
Entered:2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema, Intussusception, Vomiting, X-ray, Ultrasound abdomen, Blood test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC 'Split Type':

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=386671&WAYBACKHISTORY=ON


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