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This is VAERS ID 425901

History of Changes from the VAERS Wayback Machine

First Appeared on 7/12/2011

425901
VAERS Form:
Age:0.2
Gender:Male
Location:Michigan
Vaccinated:2011-06-01
Onset:2011-06-05
Submitted:2011-06-10
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC 'Split Type':

Write-up:6/6/11 acute vomiting.


Changed on 5/13/2013

425901 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Michigan
Vaccinated:2011-06-01
Onset:2011-06-05
Submitted:2011-06-10
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC 'Split Type':

Write-up:6/6/11 acute vomiting.


Changed on 6/14/2014

425901 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Michigan
Vaccinated:2011-06-01
Onset:2011-06-05
Submitted:2011-06-10
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC 'Split Type':

Write-up:6/6/11 acute vomiting.


Changed on 2/14/2017

425901 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:Michigan
Vaccinated:2011-06-01
Onset:2011-06-05
Submitted:2011-06-10
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC 'Split Type':

Write-up:6/6/11 acute vomiting.


Changed on 4/14/2017

425901 Before After
VAERS Form:
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2011-06-01
Onset:2011-06-05
Submitted:2011-06-10
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC 'Split Type':

Write-up:6/6/11 acute vomiting.


Changed on 9/14/2017

425901 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2011-06-01
Onset:2011-06-05
Submitted:2011-06-10
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 0 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 1 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 0 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC 'Split Type':

Write-up:6/6/11 acute vomiting.


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