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This is VAERS ID 311018

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 311018
VAERS Form:
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 5/13/2013

VAERS ID: 311018 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 9/14/2017

VAERS ID: 311018 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 2/14/2018

VAERS ID: 311018 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 6/14/2018

VAERS ID: 311018 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 8/14/2018

VAERS ID: 311018 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 9/14/2018

VAERS ID: 311018 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Foreign
Vaccinated:2008-04-03
Onset:2008-04-04
Submitted:2008-04-25
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Blood creatinine increased, Blood glucose normal, Blood thromboplastin, Dehydration, Haematochezia, Haemoglobin normal, Hyperaemia, Intussusception, Malaise, Mucous stools, Pallor, Prothrombin time prolonged, Pyrexia, Surgery, Upper respiratory tract infection, Vomiting, Platelet count increased, Pharyngeal erythema, Abdominal X-ray, Oral intake reduced, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray 10Apr2008 see text unit; Blood glucose 10Apr2008 107mg/dl; Creatinine 10Apr2008 0.5mg/dl; Hemoglobin 10Apr2008 12.8g/dl; Platelet count 10Apr2008 618000mm3; Prothrombin time 10Apr2008 12.7s; Thromboplastin 10Apr2008 42.3s
CDC 'Split Type': B0517189A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included live attenuated human rotavirus vaccine (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 3 April 2008. On 3 April 2008 the subject received 2nd dose of ROTARIX (oral). On 4 April 2008, 1 day after vaccination with ROTARIX, the subject presented upper respiratory tract infection not specified and characterised by fever, vomiting and not oral acceptance. The subject was treated with Paracetamol and Ampicillin without improvement. On 7 April 2008, the subject continued with vomiting and fever. On 10 April 2008 the subject was brought to the emergency room with persisting fever, vomiting and mucosanguinolent stool. at physical examination he showed dehydration, malaise, pallor, pharyngeal hyperemia, abdominal pain timpanic and distended, absent bowel sound and rectal tract with evidence of current jelly stools. Relevant test results included abdominal x-ray which showed suggestive image of intussusception, dilated small bowel and lack of air in distal colon. Therefore the same day the subject underwent a surgery. Ileocecal intussusception was found without complications in intestinal loops, only reduction by taxis was done. After that the subject''s clinical condition was favorable. On 15 April 2008 the subject was discharged. The physician considered the events were possibly related to vaccination with ROTARIX.

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