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This is VAERS ID 424301

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2011

VAERS ID: 424301
VAERS Form:
Age:0.2
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
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.


Changed on 5/13/2013

VAERS ID: 424301 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
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.


Changed on 6/14/2014

VAERS ID: 424301 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
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.


Changed on 2/14/2017

VAERS ID: 424301 Before After
VAERS Form:
Age:0.2 0.24
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     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.


Changed on 4/14/2017

VAERS ID: 424301 Before After
VAERS Form:
Age:0.24
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
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.


Changed on 9/14/2017

VAERS ID: 424301 Before After
VAERS Form:(blank) 1
Age:0.24
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
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.


Changed on 2/14/2018

VAERS ID: 424301 Before After
VAERS Form:1
Age:0.24
Gender:Male
Location:Connecticut
Vaccinated:2011-05-17
Onset:2011-05-21
Submitted:2011-05-23
Entered:2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB157A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, Laparoscopic surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=424301&WAYBACKHISTORY=ON


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