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This is VAERS ID 522387

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2014

522387
VAERS Form:
Age:0.2
Gender:Male
Location:Alabama
Vaccinated:2013-12-06
Onset:2013-12-12
Submitted:2014-02-05
Entered:2014-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5A5T5 / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH854AB / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G66539 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB355A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Haematochezia, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Impetigo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd. Ultrasound/Barium enema
CDC 'Split Type':

Write-up:Went to ER due to vomiting and bloody stools, also lethargic on 12-12-13 was admitted. Abd. ultrasound and barium enema was done. Was diagnosed with intussusception. Was taken to surgery where he had 2 inches of colon removed.


Changed on 6/14/2014

522387 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Alabama
Vaccinated:2013-12-06
Onset:2013-12-12
Submitted:2014-02-05
Entered:2014-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5A5T5 / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH854AB / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G66539 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB355A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Haematochezia, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Impetigo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd. Ultrasound/Barium enema
CDC 'Split Type':

Write-up:Went to ER due to vomiting and bloody stools, also lethargic on 12-12-13 was admitted. Abd. ultrasound and barium enema was done. Was diagnosed with intussusception. Was taken to surgery where he had 2 inches of colon removed.


Changed on 3/14/2015

522387 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Alabama
Vaccinated:2013-12-06
Onset:2013-12-12
Submitted:2014-02-05
Entered:2014-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5A5T5 / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH854AB / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G66539 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB355A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Haematochezia, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Impetigo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd. Ultrasound/Barium enema
CDC 'Split Type':

Write-up:Went to ER due to vomiting and bloody stools, also lethargic on 12-12-13 was admitted. Abd. ultrasound and barium enema was done. Was diagnosed with intussusception. Was taken to surgery where he had 2 inches of colon removed.


Changed on 2/14/2017

522387 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:Alabama
Vaccinated:2013-12-06
Onset:2013-12-12
Submitted:2014-02-05
Entered:2014-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5A5T5 / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH854AB / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G66539 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB355A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Haematochezia, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Impetigo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd. Ultrasound/Barium enema
CDC 'Split Type':

Write-up:Went to ER due to vomiting and bloody stools, also lethargic on 12-12-13 was admitted. Abd. ultrasound and barium enema was done. Was diagnosed with intussusception. Was taken to surgery where he had 2 inches of colon removed.


Changed on 9/14/2017

522387 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:Alabama
Vaccinated:2013-12-06
Onset:2013-12-12
Submitted:2014-02-05
Entered:2014-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5A5T5 / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH854AB / 0 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G66539 / 1 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB355A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Haematochezia, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Impetigo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd. Ultrasound/Barium enema
CDC 'Split Type':

Write-up:Went to ER due to vomiting and bloody stools, also lethargic on 12-12-13 was admitted. Abd. ultrasound and barium enema was done. Was diagnosed with intussusception. Was taken to surgery where he had 2 inches of colon removed.


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