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This is VAERS ID 412547

History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

412547
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2010-10-11
Onset:2010-11-26
Submitted:2010-12-13
Entered:2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intussusception, Surgery, Vomiting, Intestinal malrotation

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC 'Split Type': TX2010133PR

Write-up:STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


Changed on 5/13/2013

412547 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2010-10-11
Onset:2010-11-26
Submitted:2010-12-13
Entered:2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intussusception, Surgery, Vomiting, Intestinal malrotation

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC 'Split Type': TX2010133PR

Write-up:STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


Changed on 6/14/2014

412547 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2010-10-11
Onset:2010-11-26
Submitted:2010-12-13
Entered:2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intussusception, Surgery, Vomiting, Intestinal malrotation

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC 'Split Type': TX2010133PR

Write-up:STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


Changed on 2/14/2017

412547 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:Texas
Vaccinated:2010-10-11
Onset:2010-11-26
Submitted:2010-12-13
Entered:2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intussusception, Surgery, Vomiting, Intestinal malrotation

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC 'Split Type': TX2010133PR

Write-up:STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


Changed on 4/14/2017

412547 Before After
VAERS Form:
Age:0.17
Gender:Male
Location:Texas
Vaccinated:2010-10-11
Onset:2010-11-26
Submitted:2010-12-13
Entered:2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intussusception, Surgery, Vomiting, Intestinal malrotation

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC 'Split Type': TX2010133PR

Write-up:STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


Changed on 9/14/2017

412547 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:Texas
Vaccinated:2010-10-11
Onset:2010-11-26
Submitted:2010-12-13
Entered:2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intussusception, Surgery, Vomiting, Intestinal malrotation

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC 'Split Type': TX2010133PR

Write-up:STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


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