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This is VAERS ID 309529

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 309529
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocyte
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 5/13/2013

VAERS ID: 309529 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocyte
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 4/14/2017

VAERS ID: 309529 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocyte Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 9/14/2017

VAERS ID: 309529 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 2/14/2018

VAERS ID: 309529 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 6/14/2018

VAERS ID: 309529 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 8/14/2018

VAERS ID: 309529 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 9/14/2018

VAERS ID: 309529 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.


Changed on 10/14/2018

VAERS ID: 309529 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2007-12-31
Onset:2008-01-19
Submitted:2008-04-15
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Hypertrophy, Intussusception, Peristalsis visible, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Aspiration biopsy, Band neutrophil percentage increased, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 20Jan2008, Abnormalunit; Air contrast barium enema, 20Jan2008, Invaginationunit; Aspiration biopsy, 20Jan2008, Negativeunit; Band neutrophil percentage, 20Jan2008, 6%; Fecal occult blood, 20Jan2008, positiveunit; Lymphocytes, 20Jan2008, 18%; Neutrophils, 20Jan2008, 71%; Platelet count, 20Jan2008, 820000/mm3; White blood cells, 20Jan2008, 23800/mm3
CDC 'Split Type': B0508483A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with Rotarix (GlaxoSmithKline). Previous and/or concurrent vaccination included DTaP + IPV + Hib; manufacturer unspecified; intramuscular; given on 30 October 2007 and on 31 December 2007; Hep B; manufacturer unspecified; intramuscular; given on 2 September 2007 and on 30 October 2007; Rotarix; GlaxoSmithKline; oral given on 30 October 2007; tuberculosis vaccine; manufacturer unspecified; intradermal; given on 2 September 2007. On 31 December 2007, the subject received 2nd dose of Rotarix (oral), lot number not provided. On 19 January 2008, 19 days after vaccination with Rotarix, the subject experienced one bloody stool. On 20 January 2008, he experienced 3 times vomiting. The subject was brought to emergency ward. At examination, abdominal pain with normal peristalsis was found. He experienced current jelly stool and intussusception was suspected. The laboratory tests showed white blood cell 23800/mm3, neutrophils 71%, neutrophil band 6%, lymphocytes 18%, platelets 820000/mm3. The fecal occult blood test was positive whereas the fine needle aspiration biopsy was negative. Abdominal X-ray showed air fluid level with distal gas. The diagnosis of intussusception was confirmed by the barium air enema. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). On 20 January 2008, surgery was performed and ileocolic intussusception of 20 cm was found as well as Peyer plaques hypertrophy. The intussusception was reduced without complication. No resection was performed. On 23 January 2008, the events were resolved. The subject was discharged from hospital on 25 January 2008 in good clinical condition. The physician considered the events were possibly related to vaccination with Rotarix. Follow-up received on 9 April 2008: The events were resolved on 25 January 2008.

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