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This is VAERS ID 544001

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2014

VAERS ID: 544001
VAERS Form:
Age:0.3
Gender:Female
Location:Florida
Vaccinated:2014-09-09
Onset:2014-09-16
Submitted:2014-09-17
Entered:2014-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7J77Y / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016186 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H69837 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB430A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound
CDC 'Split Type':

Write-up: Patient presented with bloody stools and emesis and had intussusception confirmed on ultrasound


Changed on 2/14/2017

VAERS ID: 544001 Before After
VAERS Form:
Age:0.3 0.34
Gender:Female
Location:Florida
Vaccinated:2014-09-09
Onset:2014-09-16
Submitted:2014-09-17
Entered:2014-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7J77Y / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016186 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H69837 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB430A / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound
CDC 'Split Type':

Write-up: Patient presented with bloody stools and emesis and had intussusception confirmed on ultrasound


Changed on 9/14/2017

VAERS ID: 544001 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Female
Location:Florida
Vaccinated:2014-09-09
Onset:2014-09-16
Submitted:2014-09-17
Entered:2014-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7J77Y / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016186 / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H69837 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB430A / 1 2 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound
CDC 'Split Type':

Write-up: Patient presented with bloody stools and emesis and had intussusception confirmed on ultrasound


Changed on 2/14/2018

VAERS ID: 544001 Before After
VAERS Form:1
Age:0.34
Gender:Female
Location:Florida
Vaccinated:2014-09-09
Onset:2014-09-16
Submitted:2014-09-17
Entered:2014-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7J77Y / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016186 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H69837 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB430A / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound
CDC 'Split Type':

Write-up: Patient presented with bloody stools and emesis and had intussusception confirmed on ultrasound


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