National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 416084

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2011

VAERS ID: 416084
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / - RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 06572 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 3/11/2011

VAERS ID: 416084 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / - 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 06572 0657Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / - 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / - 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 4/13/2011

VAERS ID: 416084 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Blood calcium decreased, Blood chloride increased, Blood culture positive, Blood potassium decreased, Crying, Decreased activity, Diarrhoea, Gram stain positive, Haematochezia, Haematocrit decreased, Hypersomnia, Intussusception, Lethargy, Melaena, Opisthotonus, Pyrexia, Staring, Surgery, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count decreased, X-ray abnormal, Mental status changes, Platelet count increased, Basophil percentage increased, Neutrophil percentage decreased, Monocyte percentage increased, Explorative laparotomy, Decreased appetite, Gastric occult blood positive

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 5/13/2011

VAERS ID: 416084 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Blood calcium decreased, Blood chloride increased, Blood culture positive, Blood potassium decreased, Crying, Decreased activity, Diarrhoea, Gram stain positive, Haematochezia, Haematocrit decreased, Hypersomnia, Intussusception, Lethargy, Melaena, Opisthotonus, Pyrexia, Staring, Surgery, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count decreased, X-ray abnormal, Mental status changes, Platelet count increased, Basophil percentage increased, Neutrophil percentage decreased, Monocyte percentage increased, Explorative laparotomy, Decreased appetite, Gastric occult blood positive

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 5/13/2013

VAERS ID: 416084 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 2/14/2017

VAERS ID: 416084 Before After
VAERS Form:
Age:0.2 0.21
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 9/14/2017

VAERS ID: 416084 Before After
VAERS Form:(blank) 1
Age:0.21
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 0 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 2/14/2018

VAERS ID: 416084 Before After
VAERS Form:1
Age:0.21
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


Changed on 6/14/2018

VAERS ID: 416084 Before After
VAERS Form:1
Age:0.21
Gender:Female
Location:Virginia
Vaccinated:2011-01-20
Onset:2011-01-24
Submitted:2011-02-02
Entered:2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Lethargy, Surgery, Vomiting

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.

New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=416084&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166