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This is VAERS ID 463115

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 463115
VAERS Form:
Age:0.5
Gender:Female
Location:Hawaii
Vaccinated:2012-08-14
Onset:2012-08-21
Submitted:2012-08-24
Entered:2012-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4184AB / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC103AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Ultrasound scan, X-ray, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Plain films, ultrasound, barium/air enema
CDC 'Split Type':

Write-up: Intussusception.


Changed on 5/13/2013

VAERS ID: 463115 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Hawaii
Vaccinated:2012-08-14
Onset:2012-08-21
Submitted:2012-08-24
Entered:2012-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4184AB / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC103AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Ultrasound scan, X-ray, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Plain films, ultrasound, barium/air enema
CDC 'Split Type':

Write-up: Intussusception.


Changed on 2/14/2017

VAERS ID: 463115 Before After
VAERS Form:
Age:0.5 0.54
Gender:Female
Location:Hawaii
Vaccinated:2012-08-14
Onset:2012-08-21
Submitted:2012-08-24
Entered:2012-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4184AB / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC103AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Ultrasound scan, X-ray, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Plain films, ultrasound, barium/air enema
CDC 'Split Type':

Write-up: Intussusception.


Changed on 9/14/2017

VAERS ID: 463115 Before After
VAERS Form:(blank) 1
Age:0.54
Gender:Female
Location:Hawaii
Vaccinated:2012-08-14
Onset:2012-08-21
Submitted:2012-08-24
Entered:2012-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4184AB / 1 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC103AA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Ultrasound scan, X-ray, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Plain films, ultrasound, barium/air enema
CDC 'Split Type':

Write-up: Intussusception.


Changed on 2/14/2018

VAERS ID: 463115 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Hawaii
Vaccinated:2012-08-14
Onset:2012-08-21
Submitted:2012-08-24
Entered:2012-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4184AB / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC103AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Ultrasound scan, X-ray, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Plain films, ultrasound, barium/air enema
CDC 'Split Type':

Write-up: Intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=463115&WAYBACKHISTORY=ON


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