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This is VAERS ID 450583

History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2012

VAERS ID: 450583
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 4/11/2012

VAERS ID: 450583 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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? No Yes, days: (blank) 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 5/13/2013

VAERS ID: 450583 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 6/14/2014

VAERS ID: 450583 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 3/14/2015

VAERS ID: 450583 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 2/14/2017

VAERS ID: 450583 Before After
VAERS Form:
Age:0.4 0.36
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 9/14/2017

VAERS ID: 450583 Before After
VAERS Form:(blank) 1
Age:0.36
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 2/14/2018

VAERS ID: 450583 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


Changed on 6/14/2018

VAERS ID: 450583 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Illinois
Vaccinated:2011-12-30
Onset:2012-01-23
Submitted:2012-02-27
Entered:2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC 'Split Type':

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.

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