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This is VAERS ID 515482

History of Changes from the VAERS Wayback Machine

First Appeared on 12/13/2013

VAERS ID: 515482
VAERS Form:
Age:0.2
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 0 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 3/14/2014

VAERS ID: 515482 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) DTAP + HEPB + IPV (PEDIARIX) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS - 7449K / 0 UN RL / UN IM
HIBV: HIB (NO BRAND NAME) HIB (PEDVAXHIB) / UNKNOWN MANUFACTURER MERCK & CO. INC. - J010385 / 0 UN LL / UN IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - G57035 / 0 UN RL / UN IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - AHDB397A / 0 UN - / UN PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 2/14/2017

VAERS ID: 515482 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 9/14/2017

VAERS ID: 515482 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 2/14/2018

VAERS ID: 515482 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 6/14/2018

VAERS ID: 515482 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 8/14/2018

VAERS ID: 515482 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


Changed on 9/14/2018

VAERS ID: 515482 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Nevada
Vaccinated:2013-11-21
Onset:2013-11-26
Submitted:2013-12-03
Entered:2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient taken to OR -$g hemicolectomy
CDC 'Split Type':

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.

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