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This is VAERS ID 456491

History of Changes from the VAERS Wayback Machine

First Appeared on 6/13/2012

VAERS ID: 456491
VAERS Form:
Age:0.3
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 5/13/2013

VAERS ID: 456491 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 6/14/2014

VAERS ID: 456491 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 2/14/2017

VAERS ID: 456491 Before After
VAERS Form:
Age:0.3 0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 4/14/2017

VAERS ID: 456491 Before After
VAERS Form:
Age:0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 9/14/2017

VAERS ID: 456491 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 2/14/2018

VAERS ID: 456491 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 6/14/2018

VAERS ID: 456491 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 8/14/2018

VAERS ID: 456491 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


Changed on 9/14/2018

VAERS ID: 456491 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Tennessee
Vaccinated:2012-02-28
Onset:2012-03-22
Submitted:2012-05-30
Entered:2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, X-ray, Occult blood, Metabolic function test

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC 'Split Type':

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.

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