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This is VAERS ID 458920

History of Changes from the VAERS Wayback Machine

First Appeared on 7/13/2012

VAERS ID: 458920
VAERS Form:
Age:0.3
Gender:Female
Location:New York
Vaccinated:2012-07-03
Onset:2012-07-09
Submitted:2012-07-09
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B323AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 107088 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F51182 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB287A / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception with bowel obstruction.


Changed on 5/13/2013

VAERS ID: 458920 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:New York
Vaccinated:2012-07-03
Onset:2012-07-09
Submitted:2012-07-09
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B323AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 107088 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F51182 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB287A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB287A / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception with bowel obstruction.


Changed on 2/14/2017

VAERS ID: 458920 Before After
VAERS Form:
Age:0.3 0.34
Gender:Female
Location:New York
Vaccinated:2012-07-03
Onset:2012-07-09
Submitted:2012-07-09
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B323AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 107088 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F51182 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB287A / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception with bowel obstruction.


Changed on 9/14/2017

VAERS ID: 458920 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Female
Location:New York
Vaccinated:2012-07-03
Onset:2012-07-09
Submitted:2012-07-09
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B323AA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 107088 / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F51182 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB287A / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception with bowel obstruction.


Changed on 2/14/2018

VAERS ID: 458920 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:New York
Vaccinated:2012-07-03
Onset:2012-07-09
Submitted:2012-07-09
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B323AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 107088 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F51182 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB287A / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception with bowel obstruction.


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