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This is VAERS ID 523871

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2014

VAERS ID: 523871
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 4/14/2014

VAERS ID: 523871 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: (blank) 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 6/14/2014

VAERS ID: 523871 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 3/14/2015

VAERS ID: 523871 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 2/14/2017

VAERS ID: 523871 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 9/14/2017

VAERS ID: 523871 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - UNK LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - UNK LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - UNK - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 2/14/2018

VAERS ID: 523871 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / UNK LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / UNK LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / UNK MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


Changed on 6/14/2018

VAERS ID: 523871 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Louisiana
Vaccinated:2014-02-18
Onset:2014-02-21
Submitted:2014-02-24
Entered:2014-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / UNK LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / UNK LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / UNK MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Urinary system X-ray, X-ray abnormal, Mental status changes, Enema administration

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC 'Split Type':

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.

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