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This is VAERS ID 476119

History of Changes from the VAERS Wayback Machine

First Appeared on 12/11/2012

VAERS ID: 476119
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 5/13/2013

VAERS ID: 476119 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 8/12/2013

VAERS ID: 476119 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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 Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: (blank) 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 6/14/2014

VAERS ID: 476119 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 3/14/2015

VAERS ID: 476119 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 2/14/2017

VAERS ID: 476119 Before After
VAERS Form:
Age:0.4 0.42
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 9/14/2017

VAERS ID: 476119 Before After
VAERS Form:(blank) 1
Age:0.42
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


Changed on 2/14/2018

VAERS ID: 476119 Before After
VAERS Form:1
Age:0.42
Gender:Male
Location:Florida
Vaccinated:2012-10-01
Onset:2012-10-11
Submitted:2012-12-03
Entered:2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had intussusception and had surgical repair at Hospital.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=476119&WAYBACKHISTORY=ON


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