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This is VAERS ID 433714

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 433714
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 5/13/2013

VAERS ID: 433714 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 2/14/2017

VAERS ID: 433714 Before After
VAERS Form:
Age:0.3 0.26
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 9/14/2017

VAERS ID: 433714 Before After
VAERS Form:(blank) 1
Age:0.26
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 2/14/2018

VAERS ID: 433714 Before After
VAERS Form:1
Age:0.26
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 6/14/2018

VAERS ID: 433714 Before After
VAERS Form:1
Age:0.26
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 8/14/2018

VAERS ID: 433714 Before After
VAERS Form:1
Age:0.26
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


Changed on 9/14/2018

VAERS ID: 433714 Before After
VAERS Form:1
Age:0.26
Gender:Female
Location:North Carolina
Vaccinated:2011-07-25
Onset:2011-07-29
Submitted:2011-09-07
Entered:2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Intestinal operation

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC 'Split Type':

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.

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