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This is VAERS ID 378753

(NOTE: This result is from the 3/14/2015 version of the VAERS database)

Case Details

VAERS ID: 378753 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Connecticut  
Vaccinated:2010-01-20
Onset:2010-01-23
   Days after vaccination:3
Submitted: 2010-01-27
   Days after onset:4
Entered: 2010-01-29
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB762CA / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA963A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain upper, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Murmur.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/16/09 ROTARIX #1-developed belly pain and vomiting. 1/20/10 ROTARIX #2-on 1/23/10 intussusception.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150314&IDNUMBER=378753


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