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This is VAERS ID 528141

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2014

VAERS ID: 528141
VAERS Form:
Age:0.2
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


Changed on 5/16/2014

VAERS ID: 528141 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


Changed on 6/14/2014

VAERS ID: 528141 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


Changed on 3/14/2015

VAERS ID: 528141 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


Changed on 2/14/2017

VAERS ID: 528141 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


Changed on 9/14/2017

VAERS ID: 528141 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


Changed on 2/14/2018

VAERS ID: 528141 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Oklahoma
Vaccinated:2014-03-24
Onset:2014-03-29
Submitted:2014-04-10
Entered:2014-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC 'Split Type':

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.

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