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This is VAERS ID 524481

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2014

VAERS ID: 524481
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2013-07-11
Onset:2013-10-09
Submitted:2014-03-04
Entered:2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5GS71 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J000360 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G31938 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB292A / 2 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Sickle cell trait, umbilical hernia, feeding problems in the newborn
Allergies:
Diagnostic Lab Data: Ultrasound for diagnosis and air enema for reduction.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound reduced by air enema October 9th, 2013. Observed overnight, discharged home in good condition October 10th, 2013.


Changed on 6/14/2014

VAERS ID: 524481 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2013-07-11
Onset:2013-10-09
Submitted:2014-03-04
Entered:2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5GS71 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J000360 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G31938 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB292A / 2 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Sickle cell trait, umbilical hernia, feeding problems in the newborn
Allergies:
Diagnostic Lab Data: Ultrasound for diagnosis and air enema for reduction.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound reduced by air enema October 9th, 2013. Observed overnight, discharged home in good condition October 10th, 2013.


Changed on 3/14/2015

VAERS ID: 524481 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2013-07-11
Onset:2013-10-09
Submitted:2014-03-04
Entered:2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5GS71 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J000360 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G31938 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB292A / 2 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Sickle cell trait, umbilical hernia, feeding problems in the newborn
Allergies:
Diagnostic Lab Data: Ultrasound for diagnosis and air enema for reduction.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound reduced by air enema October 9th, 2013. Observed overnight, discharged home in good condition October 10th, 2013.


Changed on 9/14/2017

VAERS ID: 524481 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2013-07-11
Onset:2013-10-09
Submitted:2014-03-04
Entered:2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5GS71 / 2 3 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J000360 / 2 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G31938 / 2 3 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB292A / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Sickle cell trait, umbilical hernia, feeding problems in the newborn
Allergies:
Diagnostic Lab Data: Ultrasound for diagnosis and air enema for reduction.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound reduced by air enema October 9th, 2013. Observed overnight, discharged home in good condition October 10th, 2013.


Changed on 2/14/2018

VAERS ID: 524481 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2013-07-11
Onset:2013-10-09
Submitted:2014-03-04
Entered:2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5GS71 / 3 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J000360 / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G31938 / 3 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB292A / 3 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Sickle cell trait, umbilical hernia, feeding problems in the newborn
Allergies:
Diagnostic Lab Data: Ultrasound for diagnosis and air enema for reduction.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound reduced by air enema October 9th, 2013. Observed overnight, discharged home in good condition October 10th, 2013.


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