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This is VAERS ID 495671

History of Changes from the VAERS Wayback Machine

First Appeared on 7/7/2013

495671
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2013-05-13
Onset:2013-06-27
Submitted:2013-07-02
Entered:2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4359AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75071 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB346A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Condition aggravated, Dehydration, Intussusception, Irritability, Vomiting, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI; Mild ROM; Vomiting day before
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; Barium enema
CDC 'Split Type':

Write-up:6.27.13 started with vomiting; 6.28.13 vomiting and very fussy, dehydrated. Sent to hospital for evaluation and IV rehydration. Intussusception diagnosed and treated by barium enema.


Changed on 9/17/2013

495671 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2013-05-13
Onset:2013-06-27
Submitted:2013-07-02
Entered:2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4359AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75071 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB346A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Condition aggravated, Dehydration, Intussusception, Irritability, Vomiting, Abdominal X-ray

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: 2 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI; Mild ROM; Vomiting day before
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; Barium enema
CDC 'Split Type':

Write-up:6.27.13 started with vomiting; 6.28.13 vomiting and very fussy, dehydrated. Sent to hospital for evaluation and IV rehydration. Intussusception diagnosed and treated by barium enema.


Changed on 2/14/2017

495671 Before After
VAERS Form:
Age:0.3 0.34
Gender:Male
Location:Michigan
Vaccinated:2013-05-13
Onset:2013-06-27
Submitted:2013-07-02
Entered:2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4359AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75071 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB346A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Condition aggravated, Dehydration, Intussusception, Irritability, Vomiting, Abdominal X-ray

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:
Current Illness: Mild URI; Mild ROM; Vomiting day before
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; Barium enema
CDC 'Split Type':

Write-up:6.27.13 started with vomiting; 6.28.13 vomiting and very fussy, dehydrated. Sent to hospital for evaluation and IV rehydration. Intussusception diagnosed and treated by barium enema.


Changed on 9/14/2017

495671 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Male
Location:Michigan
Vaccinated:2013-05-13
Onset:2013-06-27
Submitted:2013-07-02
Entered:2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4359AA / 1 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75071 / 1 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB346A / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Condition aggravated, Dehydration, Intussusception, Irritability, Vomiting, Abdominal X-ray

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:
Current Illness: Mild URI; Mild ROM; Vomiting day before
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; Barium enema
CDC 'Split Type':

Write-up:6.27.13 started with vomiting; 6.28.13 vomiting and very fussy, dehydrated. Sent to hospital for evaluation and IV rehydration. Intussusception diagnosed and treated by barium enema.


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