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This is VAERS ID 542759

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2014

VAERS ID: 542759
VAERS Form:
Age:0.2
Gender:Male
Location:Minnesota
Vaccinated:2014-08-22
Onset:2014-08-27
Submitted:2014-08-27
Entered:2014-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B23P9 / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H33597 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB416A / 0 - / PO

Administered by: Public      Purchased by: Private
Symptoms: Intussusception, Vomiting, Ultrasound abdomen, Abdominal X-ray

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound/Xray
CDC 'Split Type':

Write-up: Intussusception - fluoroscopically reduced. Presented with vomiting.


Changed on 2/14/2017

VAERS ID: 542759 Before After
VAERS Form:
Age:0.2 0.21
Gender:Male
Location:Minnesota
Vaccinated:2014-08-22
Onset:2014-08-27
Submitted:2014-08-27
Entered:2014-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B23P9 / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H33597 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB416A / 0 - / PO

Administered by: Public      Purchased by: Private
Symptoms: Intussusception, Vomiting, Ultrasound abdomen, Abdominal X-ray

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound/Xray
CDC 'Split Type':

Write-up: Intussusception - fluoroscopically reduced. Presented with vomiting.


Changed on 9/14/2017

VAERS ID: 542759 Before After
VAERS Form:(blank) 1
Age:0.21
Gender:Male
Location:Minnesota
Vaccinated:2014-08-22
Onset:2014-08-27
Submitted:2014-08-27
Entered:2014-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B23P9 / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H33597 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB416A / 0 1 - MO / PO

Administered by: Public      Purchased by: Private
Symptoms: Intussusception, Vomiting, Ultrasound abdomen, Abdominal X-ray

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound/Xray
CDC 'Split Type':

Write-up: Intussusception - fluoroscopically reduced. Presented with vomiting.


Changed on 2/14/2018

VAERS ID: 542759 Before After
VAERS Form:1
Age:0.21
Gender:Male
Location:Minnesota
Vaccinated:2014-08-22
Onset:2014-08-27
Submitted:2014-08-27
Entered:2014-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B23P9 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H33597 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB416A / 1 MO / PO

Administered by: Public      Purchased by: Private
Symptoms: Intussusception, Vomiting, Ultrasound abdomen, Abdominal X-ray

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound/Xray
CDC 'Split Type':

Write-up: Intussusception - fluoroscopically reduced. Presented with vomiting.

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