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This is VAERS ID 558082

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2014

VAERS ID: 558082
VAERS Form:
Age:0.2
Gender:Female
Location:Florida
Vaccinated:2014-12-08
Onset:2014-12-08
Submitted:2014-12-12
Entered:2014-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 232P5 / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K002935 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH J11486 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB452A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen abnormal

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: None
Current Illness: No
Preexisting Conditions: Drug withdrawal syndrome
Allergies:
Diagnostic Lab Data: U/S to diagnose
CDC 'Split Type':

Write-up: Now has ileo-ileo intussusception. Home today or tomorrow. Dx Abd U/S.


Changed on 2/14/2017

VAERS ID: 558082 Before After
VAERS Form:
Age:0.2 0.23
Gender:Female
Location:Florida
Vaccinated:2014-12-08
Onset:2014-12-08
Submitted:2014-12-12
Entered:2014-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 232P5 / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K002935 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH J11486 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB452A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen abnormal

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: None
Current Illness: No
Preexisting Conditions: Drug withdrawal syndrome
Allergies:
Diagnostic Lab Data: U/S to diagnose
CDC 'Split Type':

Write-up: Now has ileo-ileo intussusception. Home today or tomorrow. Dx Abd U/S.


Changed on 9/14/2017

VAERS ID: 558082 Before After
VAERS Form:(blank) 1
Age:0.23
Gender:Female
Location:Florida
Vaccinated:2014-12-08
Onset:2014-12-08
Submitted:2014-12-12
Entered:2014-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 232P5 / 0 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K002935 / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH J11486 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB452A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen abnormal

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: None
Current Illness: No
Preexisting Conditions: Drug withdrawal syndrome
Allergies:
Diagnostic Lab Data: U/S to diagnose
CDC 'Split Type':

Write-up: Now has ileo-ileo intussusception. Home today or tomorrow. Dx Abd U/S.


Changed on 2/14/2018

VAERS ID: 558082 Before After
VAERS Form:1
Age:0.23
Gender:Female
Location:Florida
Vaccinated:2014-12-08
Onset:2014-12-08
Submitted:2014-12-12
Entered:2014-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 232P5 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K002935 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH J11486 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB452A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen abnormal

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: None
Current Illness: No
Preexisting Conditions: Drug withdrawal syndrome
Allergies:
Diagnostic Lab Data: U/S to diagnose
CDC 'Split Type':

Write-up: Now has ileo-ileo intussusception. Home today or tomorrow. Dx Abd U/S.


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