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This is VAERS ID 406334

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 406334
VAERS Form:
Age:0.3
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 4/13/2011

VAERS ID: 406334 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Barium enema abnormal, Cough, Decreased activity, Dehydration, Diarrhoea, Eye discharge, Haematochezia, Intussusception, Irritability, Laparotomy, Pyrexia, Surgery, Urinary system X-ray, Viral infection, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Laparoscopic surgery, Urine output decreased, Occult blood positive, Hypophagia, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 5/13/2011

VAERS ID: 406334 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Barium enema abnormal, Cough, Decreased activity, Dehydration, Diarrhoea, Eye discharge, Haematochezia, Intussusception, Irritability, Laparotomy, Pyrexia, Surgery, Urinary system X-ray, Viral infection, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Laparoscopic surgery, Urine output decreased, Occult blood positive, Hypophagia, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 5/13/2013

VAERS ID: 406334 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 6/14/2014

VAERS ID: 406334 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 2/14/2017

VAERS ID: 406334 Before After
VAERS Form:
Age:0.3 0.34
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 4/14/2017

VAERS ID: 406334 Before After
VAERS Form:
Age:0.34
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 9/14/2017

VAERS ID: 406334 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


Changed on 2/14/2018

VAERS ID: 406334 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Colorado
Vaccinated:2010-09-01
Onset:2010-10-23
Submitted:2010-11-01
Entered:2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


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