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This is VAERS ID 414363

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2011

VAERS ID: 414363
VAERS Form:
Age:0.2
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound scan, X-ray, Food intolerance

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 4/13/2011

VAERS ID: 414363 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Anion gap increased, Barium enema abnormal, Blood creatinine decreased, Blood glucose increased, Blood potassium increased, Blood sodium decreased, Carbon dioxide decreased, Crying, Decreased activity, Gastrointestinal haemorrhage, Gram stain positive, Haematochezia, Intussusception, Leukocytosis, Lymphocyte count increased, Macrocytosis, Mean cell volume increased, Ultrasound scan, White blood cell count increased, X-ray, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Lymphocyte percentage increased, Abdominal X-ray, Occult blood positive, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 5/13/2011

VAERS ID: 414363 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Anion gap increased, Barium enema abnormal, Blood creatinine decreased, Blood glucose increased, Blood potassium increased, Blood sodium decreased, Carbon dioxide decreased, Crying, Decreased activity, Gastrointestinal haemorrhage, Gram stain positive, Haematochezia, Intussusception, Leukocytosis, Lymphocyte count increased, Macrocytosis, Mean cell volume increased, Ultrasound scan, White blood cell count increased, X-ray, X-ray abnormal, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Lymphocyte percentage increased, Abdominal X-ray, Occult blood positive, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 5/13/2013

VAERS ID: 414363 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound scan, X-ray, Food intolerance

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 2/14/2017

VAERS ID: 414363 Before After
VAERS Form:
Age:0.2 0.24
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound scan, X-ray, Food intolerance

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 9/14/2017

VAERS ID: 414363 Before After
VAERS Form:(blank) 1
Age:0.24
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound scan, X-ray, Food intolerance

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 2/14/2018

VAERS ID: 414363 Before After
VAERS Form:1
Age:0.24
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound scan, X-ray, Food intolerance

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


Changed on 6/14/2018

VAERS ID: 414363 Before After
VAERS Form:1
Age:0.24
Gender:Female
Location:Maryland
Vaccinated:2010-12-09
Onset:2010-12-26
Submitted:2011-01-06
Entered:2011-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound scan, X-ray, Food intolerance

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC 'Split Type':

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=414363&WAYBACKHISTORY=ON


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