This is VAERS ID 435124

(NOTE: This result is from the 4/14/2017 version of the VAERS database)

Case Details

VAERS ID:	435124 (history)
Form:	Version .0
Age:
Gender:	Female
Location:	Minnesota

Vaccinated:	2011-03-04
Onset:	2011-08-11
Days after vaccination:	160
Submitted:	2011-09-20
Days after onset:	40
Entered:	2011-09-21
Days after submission:	1

Vaccination / Manufacturer	Lot / Dose	Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS	A41FB096A / 1	- / PO

Administered by: Private Purchased by: Private
Symptoms: Enema administration, Exposure to communicable disease, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: In mssusc-phun of intestine~Rotavirus (no brand name)~2~1.00~Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Intestinal intussusception - reduced - air enema
CDC Split Type:

Write-up: Sudden onset bilious vomiting. Intestinal intussusception. Hospitalized - reduced with air enema. Recovered well. Hospitalization complicated by measles exposure.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170414&IDNUMBER=435124