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This is VAERS ID 457300

History of Changes from the VAERS Wayback Machine

First Appeared on 6/13/2012

VAERS ID: 457300
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 5/13/2013

VAERS ID: 457300 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 6/14/2014

VAERS ID: 457300 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 2/14/2017

VAERS ID: 457300 Before After
VAERS Form:
Age:0.2 0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 4/14/2017

VAERS ID: 457300 Before After
VAERS Form:
Age:0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 9/14/2017

VAERS ID: 457300 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 2/14/2018

VAERS ID: 457300 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 6/14/2018

VAERS ID: 457300 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 8/14/2018

VAERS ID: 457300 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


Changed on 9/14/2018

VAERS ID: 457300 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Texas
Vaccinated:2012-06-05
Onset:2012-06-09
Submitted:2012-06-12
Entered:2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Surgery, Urine analysis, Vomiting, X-ray, Laboratory 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC 'Split Type':

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.

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