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This is VAERS ID 432001

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 432001
VAERS Form:
Age:0.3
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 5/13/2013

VAERS ID: 432001 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 6/14/2014

VAERS ID: 432001 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 2/14/2017

VAERS ID: 432001 Before After
VAERS Form:
Age:0.3 0.34
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 4/14/2017

VAERS ID: 432001 Before After
VAERS Form:
Age:0.34
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 9/14/2017

VAERS ID: 432001 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 2 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 2/14/2018

VAERS ID: 432001 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 2 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


Changed on 6/14/2018

VAERS ID: 432001 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Wisconsin
Vaccinated:2011-08-09
Onset:2011-08-21
Submitted:2011-08-23
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 2 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Haematochezia, Intussusception, Lethargy, Vomiting, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC 'Split Type':

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.

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