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This is VAERS ID 547231

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2014

VAERS ID: 547231
VAERS Form:
Age:0.2
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 0 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


Changed on 2/14/2017

VAERS ID: 547231 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 0 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


Changed on 9/14/2017

VAERS ID: 547231 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 0 1 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


Changed on 2/14/2018

VAERS ID: 547231 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 1 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


Changed on 6/14/2018

VAERS ID: 547231 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 1 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


Changed on 8/14/2018

VAERS ID: 547231 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 1 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


Changed on 9/14/2018

VAERS ID: 547231 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Illinois
Vaccinated:2014-07-18
Onset:2014-08-04
Submitted:2014-10-09
Entered:2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 1 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, Ultrasound abdomen, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC 'Split Type':

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.

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