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This is VAERS ID 509638

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2013

VAERS ID: 509638
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


Changed on 3/14/2014

VAERS ID: 509638 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: (blank) 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


Changed on 6/14/2014

VAERS ID: 509638 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


Changed on 3/14/2015

VAERS ID: 509638 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


Changed on 2/14/2017

VAERS ID: 509638 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


Changed on 9/14/2017

VAERS ID: 509638 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


Changed on 2/14/2018

VAERS ID: 509638 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:California
Vaccinated:2013-10-18
Onset:2013-10-24
Submitted:2013-10-25
Entered:2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC 'Split Type':

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


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