National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 432805

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

432805
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2011-07-12
Onset:2011-07-19
Submitted:2011-08-30
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916007 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. A41CB155A / 1 - / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ROTATEQ was administered on 7/12/11. Pt. went to ER on 7/19/11 with bilious emesis - had surgery for suspicion per mother and had ileocolic intussusception.


Changed on 5/12/2012

432805 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2011-07-12
Onset:2011-07-19
Submitted:2011-08-30
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916007 / 1 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB155A / 1 - / PO
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. A41CB155A / 1 - / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ROTATEQ was administered on 7/12/11. Pt. went to ER on 7/19/11 with bilious emesis - had surgery for suspicion per mother and had ileocolic intussusception.


Changed on 5/13/2013

432805 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2011-07-12
Onset:2011-07-19
Submitted:2011-08-30
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916007 / 1 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB155A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB155A / 1 - / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ROTATEQ was administered on 7/12/11. Pt. went to ER on 7/19/11 with bilious emesis - had surgery for suspicion per mother and had ileocolic intussusception.


Changed on 2/14/2017

432805 Before After
VAERS Form:
Age:0.4 0.37
Gender:Male
Location:California
Vaccinated:2011-07-12
Onset:2011-07-19
Submitted:2011-08-30
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916007 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB155A / 1 - / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ROTATEQ was administered on 7/12/11. Pt. went to ER on 7/19/11 with bilious emesis - had surgery for suspicion per mother and had ileocolic intussusception.


Changed on 9/14/2017

432805 Before After
VAERS Form:(blank) 1
Age:0.37
Gender:Male
Location:California
Vaccinated:2011-07-12
Onset:2011-07-19
Submitted:2011-08-30
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916007 / 1 2 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB155A / 1 2 - MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ROTATEQ was administered on 7/12/11. Pt. went to ER on 7/19/11 with bilious emesis - had surgery for suspicion per mother and had ileocolic intussusception.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=432805&WAYBACKHISTORY=ON


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