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. |