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This is VAERS ID 455056

History of Changes from the VAERS Wayback Machine

First Appeared on 5/12/2012

455056
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2012-04-27
Onset:2012-04-29
Submitted:2012-05-04
Entered:2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


Changed on 5/13/2013

455056 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2012-04-27
Onset:2012-04-29
Submitted:2012-05-04
Entered:2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


Changed on 6/14/2014

455056 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2012-04-27
Onset:2012-04-29
Submitted:2012-05-04
Entered:2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


Changed on 2/14/2017

455056 Before After
VAERS Form:
Age:0.4 0.44
Gender:Male
Location:Georgia
Vaccinated:2012-04-27
Onset:2012-04-29
Submitted:2012-05-04
Entered:2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


Changed on 4/14/2017

455056 Before After
VAERS Form:
Age:0.44
Gender:Male
Location:Georgia
Vaccinated:2012-04-27
Onset:2012-04-29
Submitted:2012-05-04
Entered:2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


Changed on 9/14/2017

455056 Before After
VAERS Form:(blank) 1
Age:0.44
Gender:Male
Location:Georgia
Vaccinated:2012-04-27
Onset:2012-04-29
Submitted:2012-05-04
Entered:2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 1 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 1 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


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