National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 478201

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2013

VAERS ID: 478201
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 5/13/2013

VAERS ID: 478201 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 9/17/2013

VAERS ID: 478201 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - A41FB304A / - 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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? No Yes, days: (blank) 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 6/14/2014

VAERS ID: 478201 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 3/14/2015

VAERS ID: 478201 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 2/14/2017

VAERS ID: 478201 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 9/14/2017

VAERS ID: 478201 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 2/14/2018

VAERS ID: 478201 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 6/14/2018

VAERS ID: 478201 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 8/14/2018

VAERS ID: 478201 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


Changed on 9/14/2018

VAERS ID: 478201 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:California
Vaccinated:2012-11-30
Onset:2012-12-06
Submitted:2012-12-15
Entered:2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Vomiting, Ultrasound scan abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC 'Split Type':

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=478201&WAYBACKHISTORY=ON


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