National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 457250

History of Changes from the VAERS Wayback Machine

First Appeared on 6/13/2012

VAERS ID: 457250
VAERS Form:
Age:0.2
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 5/13/2013

VAERS ID: 457250 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 6/14/2014

VAERS ID: 457250 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 2/14/2017

VAERS ID: 457250 Before After
VAERS Form:
Age:0.2 0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 4/14/2017

VAERS ID: 457250 Before After
VAERS Form:
Age:0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 9/14/2017

VAERS ID: 457250 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 2/14/2018

VAERS ID: 457250 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 6/14/2018

VAERS ID: 457250 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 8/14/2018

VAERS ID: 457250 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


Changed on 9/14/2018

VAERS ID: 457250 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Connecticut
Vaccinated:2012-04-11
Onset:2012-06-01
Submitted:2012-06-05
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC 'Split Type':

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=457250&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166