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This is VAERS ID 435399

History of Changes from the VAERS Wayback Machine

First Appeared on 10/11/2011

VAERS ID: 435399
VAERS Form:
Age:0.3
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:0000-00-00
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254DA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 11/14/2011

VAERS ID: 435399 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:0000-00-00 2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254DA 0259AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 5/12/2012

VAERS ID: 435399 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 - / PO
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 5/13/2013

VAERS ID: 435399 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 6/14/2014

VAERS ID: 435399 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 3/14/2015

VAERS ID: 435399 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 2/14/2017

VAERS ID: 435399 Before After
VAERS Form:
Age:0.3 0.31
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 9/14/2017

VAERS ID: 435399 Before After
VAERS Form:(blank) 1
Age:0.31
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 0 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 0 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 2/14/2018

VAERS ID: 435399 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 6/14/2018

VAERS ID: 435399 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 8/14/2018

VAERS ID: 435399 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).


Changed on 9/14/2018

VAERS ID: 435399 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Rhode Island
Vaccinated:2011-09-16
Onset:2011-09-20
Submitted:2011-09-22
Entered:2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC 'Split Type':

Write-up: Intussusception on (9/20/2011).

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