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This is VAERS ID 405245

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

405245
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IJ
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER UT3645BA / - UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IJ
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IJ
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Ultrasound abdomen

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


Changed on 1/4/2011

405245 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IJ IM
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER UT3645BA / - UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IJ IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IJ IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Ultrasound abdomen

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


Changed on 4/13/2011

405245 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Blood culture negative, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen, Ultrasound abdomen abnormal, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


Changed on 5/13/2011

405245 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Blood culture negative, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen, Ultrasound abdomen abnormal, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


Changed on 5/13/2013

405245 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Ultrasound abdomen

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


Changed on 2/14/2017

405245 Before After
VAERS Form:
Age:0.6 0.56
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Ultrasound abdomen

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


Changed on 9/14/2017

405245 Before After
VAERS Form:(blank) 1
Age:0.56
Gender:Male
Location:California
Vaccinated:2010-07-12
Onset:2010-10-03
Submitted:2010-10-25
Entered:2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 3 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Ultrasound abdomen

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC 'Split Type':

Write-up:RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


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