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This is VAERS ID 525170

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2014

525170
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2014-02-12
Onset:2014-02-18
Submitted:2014-03-07
Entered:2014-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Urinary system X-ray, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Abdominal ultrasound; Barium enema
CDC 'Split Type':

Write-up:Intussusception requiring hospitalization. Intussusception occurred 6 days after rotavirus, DTaP, HepB, IPV, Hib, OMP, PCV13.


Changed on 6/14/2014

525170 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2014-02-12
Onset:2014-02-18
Submitted:2014-03-07
Entered:2014-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Urinary system X-ray, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Abdominal ultrasound; Barium enema
CDC 'Split Type':

Write-up:Intussusception requiring hospitalization. Intussusception occurred 6 days after rotavirus, DTaP, HepB, IPV, Hib, OMP, PCV13.


Changed on 3/14/2015

525170 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2014-02-12
Onset:2014-02-18
Submitted:2014-03-07
Entered:2014-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Urinary system X-ray, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Abdominal ultrasound; Barium enema
CDC 'Split Type':

Write-up:Intussusception requiring hospitalization. Intussusception occurred 6 days after rotavirus, DTaP, HepB, IPV, Hib, OMP, PCV13.


Changed on 2/14/2017

525170 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:Arizona
Vaccinated:2014-02-12
Onset:2014-02-18
Submitted:2014-03-07
Entered:2014-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Urinary system X-ray, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Abdominal ultrasound; Barium enema
CDC 'Split Type':

Write-up:Intussusception requiring hospitalization. Intussusception occurred 6 days after rotavirus, DTaP, HepB, IPV, Hib, OMP, PCV13.


Changed on 9/14/2017

525170 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:Arizona
Vaccinated:2014-02-12
Onset:2014-02-18
Submitted:2014-03-07
Entered:2014-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Urinary system X-ray, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Abdominal ultrasound; Barium enema
CDC 'Split Type':

Write-up:Intussusception requiring hospitalization. Intussusception occurred 6 days after rotavirus, DTaP, HepB, IPV, Hib, OMP, PCV13.


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