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This is VAERS ID 439014

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2011

VAERS ID: 439014
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2011-10-12
Onset:2011-10-16
Submitted:2011-10-19
Entered:2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916617 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Full blood count, Intussusception, Ultrasound scan, X-ray, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Had viral exanthem on 10/5/11
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; BMP; X-ray; Ultrasound
CDC 'Split Type':

Write-up: On 10/16/11 pt seen in ER with intussusception. Transferred.


Changed on 5/13/2013

VAERS ID: 439014 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2011-10-12
Onset:2011-10-16
Submitted:2011-10-19
Entered:2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916617 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Full blood count, Intussusception, Ultrasound scan, X-ray, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Had viral exanthem on 10/5/11
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; BMP; X-ray; Ultrasound
CDC 'Split Type':

Write-up: On 10/16/11 pt seen in ER with intussusception. Transferred.


Changed on 2/14/2017

VAERS ID: 439014 Before After
VAERS Form:
Age:0.2 0.21
Gender:Male
Location:New York
Vaccinated:2011-10-12
Onset:2011-10-16
Submitted:2011-10-19
Entered:2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916617 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Full blood count, Intussusception, Ultrasound scan, X-ray, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Had viral exanthem on 10/5/11
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; BMP; X-ray; Ultrasound
CDC 'Split Type':

Write-up: On 10/16/11 pt seen in ER with intussusception. Transferred.


Changed on 9/14/2017

VAERS ID: 439014 Before After
VAERS Form:(blank) 1
Age:0.21
Gender:Male
Location:New York
Vaccinated:2011-10-12
Onset:2011-10-16
Submitted:2011-10-19
Entered:2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916617 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Full blood count, Intussusception, Ultrasound scan, X-ray, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Had viral exanthem on 10/5/11
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; BMP; X-ray; Ultrasound
CDC 'Split Type':

Write-up: On 10/16/11 pt seen in ER with intussusception. Transferred.


Changed on 2/14/2018

VAERS ID: 439014 Before After
VAERS Form:1
Age:0.21
Gender:Male
Location:New York
Vaccinated:2011-10-12
Onset:2011-10-16
Submitted:2011-10-19
Entered:2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916617 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Full blood count, Intussusception, Ultrasound scan, X-ray, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Had viral exanthem on 10/5/11
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; BMP; X-ray; Ultrasound
CDC 'Split Type':

Write-up: On 10/16/11 pt seen in ER with intussusception. Transferred.


Changed on 6/14/2018

VAERS ID: 439014 Before After
VAERS Form:1
Age:0.21
Gender:Male
Location:New York
Vaccinated:2011-10-12
Onset:2011-10-16
Submitted:2011-10-19
Entered:2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916617 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB16CA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Full blood count, Intussusception, Ultrasound scan, X-ray, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Had viral exanthem on 10/5/11
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; BMP; X-ray; Ultrasound
CDC 'Split Type':

Write-up: On 10/16/11 pt seen in ER with intussusception. Transferred.

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=439014&WAYBACKHISTORY=ON


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