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This is VAERS ID 425873

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/12/2011

VAERS ID: 425873
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 5/13/2013

VAERS ID: 425873 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 2/14/2017

VAERS ID: 425873 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 9/14/2017

VAERS ID: 425873 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 1 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 1 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 2/14/2018

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 6/14/2018

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 8/14/2018

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 9/14/2018

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 10/14/2018

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 12/24/2020

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 12/30/2020

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 5/7/2021

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.


Changed on 5/14/2021

VAERS ID: 425873 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Illinois
Vaccinated:2011-06-16
Onset:2011-06-20
Submitted:2011-06-22
Entered:2011-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3911AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70195 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0530AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Surgery, Gastrointestinal obstruction

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 17     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UGI --$g obstruction
CDC 'Split Type':

Write-up: Surgical resection.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=425873&WAYBACKHISTORY=ON


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