National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 441799

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2011

VAERS ID: 441799
VAERS Form:
Age:0.3
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 5/13/2013

VAERS ID: 441799 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 6/14/2014

VAERS ID: 441799 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 2/14/2017

VAERS ID: 441799 Before After
VAERS Form:
Age:0.3 0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 4/14/2017

VAERS ID: 441799 Before After
VAERS Form:
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 9/14/2017

VAERS ID: 441799 Before After
VAERS Form:(blank) 1
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 2 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 2/14/2018

VAERS ID: 441799 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 6/14/2018

VAERS ID: 441799 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 8/14/2018

VAERS ID: 441799 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 9/14/2018

VAERS ID: 441799 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).


Changed on 10/14/2018

VAERS ID: 441799 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Kansas
Vaccinated:2011-10-28
Onset:2011-11-01
Submitted:2011-11-08
Entered:2011-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH266AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 9163113 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound abdomen abnormal, Hypophagia

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: Prevacid
Current Illness: None
Preexisting Conditions: Laryngomalacia Gastroesophageal reflux Pulmonic valve stenosis and peripheral pulmonary stenosis
Allergies:
Diagnostic Lab Data: Bedside ultrasound on 11/7/11 showed ''doughnut'' sign consistent with intussusception. Subsequent ultrasound on 11/7/11 no longer showed ''doughnut'' sign.
CDC 'Split Type':

Write-up: Intermittent episodes of increased fussiness, drawing up of legs, decreased oral intake. Evaluated in the Emergency Department where an bedside ultrasound showed sign of intussusception. Subsequent ultrasound when not fussy did not show evidence of intussusception (thus it spontaneously resolved without intervention).

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=441799&WAYBACKHISTORY=ON


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