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This is VAERS ID 497444

History of Changes from the VAERS Wayback Machine

First Appeared on 8/12/2013

VAERS ID: 497444
VAERS Form:
Age:0.2
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC18421AA / 2 UN / UN
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / - UN / UN

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 9/17/2013

VAERS ID: 497444 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC18421AA / 2 UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 0 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / - 0 UN LL / UN IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / - 0 UN RL / UN IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / - 0 UN - / UN PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 2/14/2017

VAERS ID: 497444 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 0 - / PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 9/14/2017

VAERS ID: 497444 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 0 1 - MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 2/14/2018

VAERS ID: 497444 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 6/14/2018

VAERS ID: 497444 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 8/14/2018

VAERS ID: 497444 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

Changed on 9/14/2018

VAERS ID: 497444 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:Michigan
Vaccinated:2013-06-03
Onset:2013-07-20
Submitted:2013-07-23
Entered:2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Dehydration, Intussusception, Vomiting, X-ray normal, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, 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: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC 'Split Type':

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.

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