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This is VAERS ID 478201

(NOTE: This result is from the 1/7/2013 version of the VAERS database)

Case Details

VAERS ID: 478201 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:2012-11-30
Onset:2012-12-06
   Days after vaccination:6
Submitted: 2012-12-15
   Days after onset:9
Entered: 2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Ultrasound scan abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC Split Type:

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130107&IDNUMBER=478201


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