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This is VAERS ID 446483

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2012

446483
VAERS Form:
Age:0.4
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-28
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


Changed on 2/13/2012

446483 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-28 2011-12-27
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: (blank) 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


Changed on 5/13/2013

446483 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-27
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


Changed on 6/14/2014

446483 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-27
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


Changed on 3/14/2015

446483 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-27
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


Changed on 2/14/2017

446483 Before After
VAERS Form:
Age:0.4 0.39
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-27
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


Changed on 9/14/2017

446483 Before After
VAERS Form:(blank) 1
Age:0.39
Gender:Female
Location:Iowa
Vaccinated:2011-12-14
Onset:2011-12-27
Submitted:2011-12-29
Entered:2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


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