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This is VAERS ID 418360

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2011

VAERS ID: 418360
VAERS Form:
Age:0.4
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 4/13/2011

VAERS ID: 418360 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood calcium increased, Blood sodium decreased, Constipation, Crying, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Screaming, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Laboratory test, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 5/13/2011

VAERS ID: 418360 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood calcium increased, Blood sodium decreased, Constipation, Crying, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Screaming, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Laboratory test, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 5/13/2013

VAERS ID: 418360 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 2/14/2017

VAERS ID: 418360 Before After
VAERS Form:
Age:0.4 0.36
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 9/14/2017

VAERS ID: 418360 Before After
VAERS Form:(blank) 1
Age:0.36
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 2/14/2018

VAERS ID: 418360 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 6/14/2018

VAERS ID: 418360 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 8/14/2018

VAERS ID: 418360 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


Changed on 9/14/2018

VAERS ID: 418360 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Mississippi
Vaccinated:2010-07-21
Onset:2010-07-21
Submitted:2011-03-10
Entered:2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Screaming, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: several
CDC 'Split Type':

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.

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