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This is VAERS ID 396263

History of Changes from the VAERS Wayback Machine

First Appeared on 8/31/2010

VAERS ID: 396263
VAERS Form:
Age:0.2
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting, Enema administration, Rectal tenesmus, Radioisotope scan normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 1/4/2011

VAERS ID: 396263 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting, Enema administration, Rectal tenesmus, Radioisotope scan normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 4/13/2011

VAERS ID: 396263 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Constipation, Dehydration, Intussusception, Irritability, Mucous stools, Sleep disorder, Vomiting, Enema administration, Ultrasound abdomen abnormal, Rectal tenesmus, Urine output decreased, Blood electrolytes normal, Radioisotope scan normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 5/13/2011

VAERS ID: 396263 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Constipation, Dehydration, Intussusception, Irritability, Mucous stools, Sleep disorder, Vomiting, Enema administration, Ultrasound abdomen abnormal, Rectal tenesmus, Urine output decreased, Blood electrolytes normal, Radioisotope scan normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 5/13/2013

VAERS ID: 396263 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 2/14/2017

VAERS ID: 396263 Before After
VAERS Form:
Age:0.2 0.18
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 9/14/2017

VAERS ID: 396263 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

Changed on 2/14/2018

VAERS ID: 396263 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:South Carolina
Vaccinated:2010-08-09
Onset:2010-08-14
Submitted:2010-08-18
Entered:2010-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3682A / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484Y / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E61989 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB05 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception =$g vomiting 8 days after vaccines; air contrast barium enema diagnosed and reduced intussusception.

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