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This is VAERS ID 507498

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2013

507498
VAERS Form:
Age:0.3
Gender:Female
Location:Ohio
Vaccinated:2013-09-30
Onset:2013-10-05
Submitted:2013-10-14
Entered:2013-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH826AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB346A / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Grunting, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Platelet count normal, Urinary system X-ray, Vomiting, White blood cell count normal, Enema administration, Ultrasound abdomen 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 15.2; Hgb 11.1; HCT 34.3; Plt 468; KUB; Abd. ultrasound confirmed intussusception
CDC 'Split Type':

Write-up:10/5/13 ER with vomiting and grunting, pulling up legs. Abd. films negative - discharged home. 10/7/13 Presented to ER with vomiting and bloody stool. 10/7/13 - Dx: ileocolic intussusception. Tx: air enema.


Changed on 2/14/2017

507498 Before After
VAERS Form:
Age:0.3 0.34
Gender:Female
Location:Ohio
Vaccinated:2013-09-30
Onset:2013-10-05
Submitted:2013-10-14
Entered:2013-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH826AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB346A / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Grunting, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Platelet count normal, Urinary system X-ray, Vomiting, White blood cell count normal, Enema administration, Ultrasound abdomen 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 15.2; Hgb 11.1; HCT 34.3; Plt 468; KUB; Abd. ultrasound confirmed intussusception
CDC 'Split Type':

Write-up:10/5/13 ER with vomiting and grunting, pulling up legs. Abd. films negative - discharged home. 10/7/13 Presented to ER with vomiting and bloody stool. 10/7/13 - Dx: ileocolic intussusception. Tx: air enema.


Changed on 9/14/2017

507498 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Female
Location:Ohio
Vaccinated:2013-09-30
Onset:2013-10-05
Submitted:2013-10-14
Entered:2013-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH826AA / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB346A / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Grunting, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Platelet count normal, Urinary system X-ray, Vomiting, White blood cell count normal, Enema administration, Ultrasound abdomen 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 15.2; Hgb 11.1; HCT 34.3; Plt 468; KUB; Abd. ultrasound confirmed intussusception
CDC 'Split Type':

Write-up:10/5/13 ER with vomiting and grunting, pulling up legs. Abd. films negative - discharged home. 10/7/13 Presented to ER with vomiting and bloody stool. 10/7/13 - Dx: ileocolic intussusception. Tx: air enema.


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