National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 389456

History of Changes from the VAERS Wayback Machine

First Appeared on 6/2/2010

VAERS ID: 389456
VAERS Form:
Age:0.1
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (UNKNOWN) / GLAXOSMITHKLINE BIOLOGICALS (UNKNOWN) 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D28551 / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in t
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 8/31/2010

VAERS ID: 389456 Before After
VAERS Form:
Age:0.1
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (UNKNOWN) DTAP+IPV+HEPB+HIB (NO BRAND NAME) / GLAXOSMITHKLINE BIOLOGICALS (UNKNOWN) 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D28551 / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in t
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 11/3/2010

VAERS ID: 389456 Before After
VAERS Form:
Age:0.1
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (NO BRAND NAME) DTAP+IPV+HEPB+HIB (FOREIGN) / GLAXOSMITHKLINE BIOLOGICALS (UNKNOWN) 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in t
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 1/4/2011

VAERS ID: 389456 Before After
VAERS Form:
Age:0.1
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN) / GLAXOSMITHKLINE BIOLOGICALS (UNKNOWN) GLAXOSMITHKLINE BIOLOGICALS 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in t the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 5/13/2013

VAERS ID: 389456 Before After
VAERS Form:
Age:0.1
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 6/14/2014

VAERS ID: 389456 Before After
VAERS Form:
Age:0.1
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 2/14/2017

VAERS ID: 389456 Before After
VAERS Form:
Age:0.1 0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 5/14/2017

VAERS ID: 389456 Before After
VAERS Form:
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN) DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 9/14/2017

VAERS ID: 389456 Before After
VAERS Form:(blank) 1
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / - UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / - UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 2/14/2018

VAERS ID: 389456 Before After
VAERS Form:1
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 6/14/2018

VAERS ID: 389456 Before After
VAERS Form:1
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 8/14/2018

VAERS ID: 389456 Before After
VAERS Form:1
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 9/14/2018

VAERS ID: 389456 Before After
VAERS Form:1
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.


Changed on 10/14/2018

VAERS ID: 389456 Before After
VAERS Form:1
Age:0.14
Sex:Unknown
Location:Foreign
Vaccinated:2010-01-06
Onset:2010-01-11
Submitted:2010-05-26
Entered:2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (INFANRIX HEXA) / GLAXOSMITHKLINE BIOLOGICALS 020CA635A / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D28551 / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA987A / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature decreased, Haematochezia, Hypotonic-hyporesponsive episode, Intussusception, Rash maculo-papular, Sepsis, Ultrasound abdomen abnormal, Gastrointestinal hypomotility, Peritoneal disorder, Gastrointestinal inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Body temperature (results: 35.9 deg. C.) was done on 11-Jan-2010. Additionally, blood culture (results: negative) and ultrasound abdomen (results: revealed multiple distended bowel loops with sluggish peristalsis and minimal free fluid in the peritoneal cavity) were done on an unspecified date.
CDC 'Split Type': PLWYEH15265210

Write-up: Information regarding PREVENAR was received from a physician (case ID: N128/2010) regarding an 8-week-old patient who experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The patient received a dose on 06-Jan-2010. The patient also received a dose of ROTARIX (GlaxoSmithKline) and a dose of INFANRIX HEXA on 06-Jan-2010. On 11-Jan-2010 the patient experienced hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intussusception, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased. The child was hospitalised in Hospital A and then transferred to the Hospital for Infection Diseases due to suspicion of sepsis. The child required receiving KKC (?). Intussusception resolved spontaneously. The patient was recovering from hypotonic-hyporesponsive episode, rash maculo-papular, body temperature decreased, intestinal hyperemia, peritoneal disorder, stool bloody and bowel peristalsis decreased at the time of this report. No additional information was available at the time of this report.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=389456&WAYBACKHISTORY=ON


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