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This is VAERS ID 311428

(NOTE: This result is from the 1/5/2010 version of the VAERS database)

Case Details

VAERS ID: 311428 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Foreign  
   Days after vaccination:37
Submitted: 2008-05-02
   Days after onset:82
Entered: 2008-05-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, Intestinal resection, Intussusception, Surgery, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Abdominal X-ray 09Feb2008 see text unit; Ultrasound abdomen 09Feb2008 see text unit.
CDC Split Type: B0509214A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 4-month-old female subject who was vaccinated with ROTARIX, GlaxoSmithKline. Previous vaccination included INFANRIX HEXA, GlaxoSmithKline; intramuscular, 1st dose left low inferior member given on 4 December 2007; PREVENAR; Wyeth Labs; intramuscular, 1st dose; right low inferior member given on 4 December 2007. On 3 January 2008 the subject received 1st dose of ROTARIX (oral). On 08 February 2008 the subject received the second dose of INFANRIX HEXA and PREVENAR. On 9 February 2008, 37 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the physician considered the event was life threatening and clinically significant (or requiring intervention). Relevant test results included abdominal x-ray which showed fluid levels and dilated bowel loops and the abdominal ultrasound showed a visible intussusception or soft tissue mass. The subject was treated with surgery on 10 February 2008. Intussusception was demonstrated at surgery. The subject required bowel resection. It was reported that complications occurred at radiological procedure but no details were provided. At the time of reporting the outcome of the event was unspecified. The physician considered the event was almost certainly related to vaccination with ROTARIX. In the follow up received on 25 April 2008 it was mentioned that the physician did not report and signs nor symptoms. Besides it was clarified that the complication at radiological procedure was an intestinal track perforation. On 15 April 2008 the subject was fully recovered.

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