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This is VAERS ID 452398

History of Changes from the VAERS Wayback Machine

First Appeared on 4/11/2012

VAERS ID: 452398
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 5/13/2013

VAERS ID: 452398 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 2/14/2017

VAERS ID: 452398 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 9/14/2017

VAERS ID: 452398 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 0 1 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 2/14/2018

VAERS ID: 452398 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 6/14/2018

VAERS ID: 452398 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 8/14/2018

VAERS ID: 452398 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.


Changed on 9/14/2018

VAERS ID: 452398 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Maryland
Vaccinated:2012-03-12
Onset:2012-03-19
Submitted:0000-00-00
Entered:2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Septic shock, Small intestinal resection, Intestinal anastomosis

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: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC 'Split Type':

Write-up: Child presented with intussusception & septic shock on 3/19/12.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=452398&WAYBACKHISTORY=ON


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