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This is VAERS ID 547775

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2014

VAERS ID: 547775
VAERS Form:
Age:0.2
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 2/14/2017

VAERS ID: 547775 Before After
VAERS Form:
Age:0.2 0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 9/14/2017

VAERS ID: 547775 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 0 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 2/14/2018

VAERS ID: 547775 Before After
VAERS Form:1
Age:0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 6/14/2018

VAERS ID: 547775 Before After
VAERS Form:1
Age:0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 8/14/2018

VAERS ID: 547775 Before After
VAERS Form:1
Age:0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 9/14/2018

VAERS ID: 547775 Before After
VAERS Form:1
Age:0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.


Changed on 10/14/2018

VAERS ID: 547775 Before After
VAERS Form:1
Age:0.19
Gender:Female
Location:North Carolina
Vaccinated:2014-08-12
Onset:2014-08-18
Submitted:2014-10-14
Entered:2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 372DT / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35553 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB425A / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Pyrexia, Ultrasound scan, X-ray, Enema administration

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: Intussusception~Rotavirus (Rotarix)~1~0.17~Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air enema reduction for intussusception x 3, xray and ultrasound done
CDC 'Split Type':

Write-up: Fever, intussusception, cefdinir given at office then changed to clindamycin during admission to hospital.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=547775&WAYBACKHISTORY=ON


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