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This is VAERS ID 431215

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 431215
VAERS Form:
Age:0.2
Gender:Male
Location:Ohio
Vaccinated:2011-08-15
Onset:2011-08-23
Submitted:2011-08-25
Entered:2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B285EA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E88940 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AU1FB162A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Ascites, Intussusception, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Obstruction

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal x ray: air fluid levels abdominal ultrasound: obstruction, ascites, intussusception barium enema: air enema reduced ileocolic intussusception
CDC 'Split Type':

Write-up: ileocolic Intussusception


Changed on 5/13/2013

VAERS ID: 431215 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Ohio
Vaccinated:2011-08-15
Onset:2011-08-23
Submitted:2011-08-25
Entered:2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B285EA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E88940 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AU1FB162A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AU1FB162A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Ascites, Intussusception, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Obstruction

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal x ray: air fluid levels abdominal ultrasound: obstruction, ascites, intussusception barium enema: air enema reduced ileocolic intussusception
CDC 'Split Type':

Write-up: ileocolic Intussusception


Changed on 2/14/2017

VAERS ID: 431215 Before After
VAERS Form:
Age:0.2 0.16
Gender:Male
Location:Ohio
Vaccinated:2011-08-15
Onset:2011-08-23
Submitted:2011-08-25
Entered:2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B285EA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E88940 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AU1FB162A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Ascites, Intussusception, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Obstruction

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal x ray: air fluid levels abdominal ultrasound: obstruction, ascites, intussusception barium enema: air enema reduced ileocolic intussusception
CDC 'Split Type':

Write-up: ileocolic Intussusception


Changed on 9/14/2017

VAERS ID: 431215 Before After
VAERS Form:(blank) 1
Age:0.16
Gender:Male
Location:Ohio
Vaccinated:2011-08-15
Onset:2011-08-23
Submitted:2011-08-25
Entered:2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B285EA / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E88940 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AU1FB162A / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Ascites, Intussusception, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Obstruction

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal x ray: air fluid levels abdominal ultrasound: obstruction, ascites, intussusception barium enema: air enema reduced ileocolic intussusception
CDC 'Split Type':

Write-up: ileocolic Intussusception


Changed on 2/14/2018

VAERS ID: 431215 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Ohio
Vaccinated:2011-08-15
Onset:2011-08-23
Submitted:2011-08-25
Entered:2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B285EA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E88940 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AU1FB162A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Ascites, Intussusception, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Obstruction

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal x ray: air fluid levels abdominal ultrasound: obstruction, ascites, intussusception barium enema: air enema reduced ileocolic intussusception
CDC 'Split Type':

Write-up: ileocolic Intussusception


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=431215&WAYBACKHISTORY=ON


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