This is VAERS ID 424301

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID:	424301 (history)
Form:	Version .0
Age:	0.24
Gender:	Male
Location:	Connecticut

Vaccinated:	2011-05-17
Onset:	2011-05-21
Days after vaccination:	4
Submitted:	2011-05-23
Days after onset:	2
Entered:	2011-05-31
Days after submission:	8

Vaccination / Manufacturer	Lot / Dose	Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS	A41CB157A / 0	- / PO

Administered by: Private Purchased by: Public
Symptoms: Intussusception, Laparoscopic surgery, 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, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Nevus (R) shin; (+) Cafe au lait (L) thigh
Allergies:
Diagnostic Lab Data: Laparoscopic surgical reduction
CDC Split Type:

Write-up: Started vomiting on 5/21/11 and went to hospital on 5/22/11 where diagnosed with intussusception which needed to be surgically reduced.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=424301