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This is VAERS ID 311430

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 311430
VAERS Form:
Age:0.4
Gender:Male
Location:Foreign
Vaccinated:2008-03-24
Onset:2008-03-24
Submitted:2008-05-02
Entered:2008-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Blood chloride increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Crying, Haematochezia, Haematocrit normal, Haemoglobin normal, Intussusception, Platelet count decreased, Vomiting, White blood cell count increased, Neutrophil percentage increased, Abdominal X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: BRONCHIOLITIS
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 25Mar2008, see textunit; Blood glucose, 25Mar2008, 113mg/dl; Chloride, 25Mar2008, 110mEq/L; Creatinine, 25Mar2008, 0.4mg/dl; Hematocrit, 25Mar2008, 33.05%; Hemoglobin, 25Mar2008, 10.83g/dl; Leukocyte count NOS, 25Mar2008, 2
CDC 'Split Type': B0517772A

Write-up: This case was reported by a physician in the frame of a study 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 24 March 2008; Rotarix; GlaxoSmithKline; oral given on 8 January 2008. The subject''s medical history included bronchiolitis which occurred 3 weeks previous vaccination. The subject was hospitalised with good clinical evolution. No further information was available in the clinical file. On 24 March 2008 the subject received 2nd dose of Rotarix (oral). On 24 March 2008, less than one day after vaccination with Rotarix, the subject started vomiting and he had one stool like current jelly stool. The subject was treated with paracetamol and cisapride without improvement. On 25 March 2008 the subject was admitted at the emergency room with still vomiting and hematochezia. At physical examination the subject presented increasing bowel sounds and intense crying at abdominal palpation without evidence of respiratory process. Relevant test included abdominal x-ray which showed evidence of air fluid levels and lack of air in distal area. The barium enema showed invagination in ascendant colon in the first image, after that, it passed contrast medium until distal ileum successfully. The subject''s clinical evolution was favorable. On 27 March 2008 the subject was discharged in good clinical conditions. The subject was treated with Ketorolac, amikacin, ceftriaxone, nalbuphine and enema. The physician considered the events were possibly related to vaccination with Rotarix.


Changed on 5/13/2013

VAERS ID: 311430 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Foreign
Vaccinated:2008-03-24
Onset:2008-03-24
Submitted:2008-05-02
Entered:2008-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Blood chloride increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Crying, Haematochezia, Haematocrit normal, Haemoglobin normal, Intussusception, Platelet count decreased, Vomiting, White blood cell count increased, Neutrophil percentage increased, Abdominal X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: BRONCHIOLITIS
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 25Mar2008, see textunit; Blood glucose, 25Mar2008, 113mg/dl; Chloride, 25Mar2008, 110mEq/L; Creatinine, 25Mar2008, 0.4mg/dl; Hematocrit, 25Mar2008, 33.05%; Hemoglobin, 25Mar2008, 10.83g/dl; Leukocyte count NOS, 25Mar2008, 2
CDC 'Split Type': B0517772A

Write-up: This case was reported by a physician in the frame of a study 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 24 March 2008; Rotarix; GlaxoSmithKline; oral given on 8 January 2008. The subject''s medical history included bronchiolitis which occurred 3 weeks previous vaccination. The subject was hospitalised with good clinical evolution. No further information was available in the clinical file. On 24 March 2008 the subject received 2nd dose of Rotarix (oral). On 24 March 2008, less than one day after vaccination with Rotarix, the subject started vomiting and he had one stool like current jelly stool. The subject was treated with paracetamol and cisapride without improvement. On 25 March 2008 the subject was admitted at the emergency room with still vomiting and hematochezia. At physical examination the subject presented increasing bowel sounds and intense crying at abdominal palpation without evidence of respiratory process. Relevant test included abdominal x-ray which showed evidence of air fluid levels and lack of air in distal area. The barium enema showed invagination in ascendant colon in the first image, after that, it passed contrast medium until distal ileum successfully. The subject''s clinical evolution was favorable. On 27 March 2008 the subject was discharged in good clinical conditions. The subject was treated with Ketorolac, amikacin, ceftriaxone, nalbuphine and enema. The physician considered the events were possibly related to vaccination with Rotarix.


Changed on 4/14/2017

VAERS ID: 311430 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Foreign
Vaccinated:2008-03-24
Onset:2008-03-24
Submitted:2008-05-02
Entered:2008-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Blood chloride increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Crying, Haematochezia, Haematocrit normal, Haemoglobin normal, Intussusception, Platelet count decreased, Vomiting, White blood cell count increased, Neutrophil percentage increased, Abdominal X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: BRONCHIOLITIS
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 25Mar2008, see textunit; Blood glucose, 25Mar2008, 113mg/dl; Chloride, 25Mar2008, 110mEq/L; Creatinine, 25Mar2008, 0.4mg/dl; Hematocrit, 25Mar2008, 33.05%; Hemoglobin, 25Mar2008, 10.83g/dl; Leukocyte count NOS, 25Mar2008, 2 25140mm3; Neutrophils, 25Mar2008, 78.3%; Platelet count, 25Mar2008, 244800mm3; Potassium, 25Mar2008, 4.4mEq/L; Sodium, 25Mar2008, 143mEq/L
CDC 'Split Type': B0517772A

Write-up: This case was reported by a physician in the frame of a study 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 24 March 2008; Rotarix; GlaxoSmithKline; oral given on 8 January 2008. The subject''s medical history included bronchiolitis which occurred 3 weeks previous vaccination. The subject was hospitalised with good clinical evolution. No further information was available in the clinical file. On 24 March 2008 the subject received 2nd dose of Rotarix (oral). On 24 March 2008, less than one day after vaccination with Rotarix, the subject started vomiting and he had one stool like current jelly stool. The subject was treated with paracetamol and cisapride without improvement. On 25 March 2008 the subject was admitted at the emergency room with still vomiting and hematochezia. At physical examination the subject presented increasing bowel sounds and intense crying at abdominal palpation without evidence of respiratory process. Relevant test included abdominal x-ray which showed evidence of air fluid levels and lack of air in distal area. The barium enema showed invagination in ascendant colon in the first image, after that, it passed contrast medium until distal ileum successfully. The subject''s clinical evolution was favorable. On 27 March 2008 the subject was discharged in good clinical conditions. The subject was treated with Ketorolac, amikacin, ceftriaxone, nalbuphine and enema. The physician considered the events were possibly related to vaccination with Rotarix.


Changed on 9/14/2017

VAERS ID: 311430 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Foreign
Vaccinated:2008-03-24
Onset:2008-03-24
Submitted:2008-05-02
Entered:2008-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Blood chloride increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Crying, Haematochezia, Haematocrit normal, Haemoglobin normal, Intussusception, Platelet count decreased, Vomiting, White blood cell count increased, Neutrophil percentage increased, Abdominal X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: BRONCHIOLITIS
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 25Mar2008, see textunit; Blood glucose, 25Mar2008, 113mg/dl; Chloride, 25Mar2008, 110mEq/L; Creatinine, 25Mar2008, 0.4mg/dl; Hematocrit, 25Mar2008, 33.05%; Hemoglobin, 25Mar2008, 10.83g/dl; Leukocyte count NOS, 25Mar2008, 25140mm3; Neutrophils, 25Mar2008, 78.3%; Platelet count, 25Mar2008, 244800mm3; Potassium, 25Mar2008, 4.4mEq/L; Sodium, 25Mar2008, 143mEq/L
CDC 'Split Type': B0517772A

Write-up: This case was reported by a physician in the frame of a study 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 24 March 2008; Rotarix; GlaxoSmithKline; oral given on 8 January 2008. The subject''s medical history included bronchiolitis which occurred 3 weeks previous vaccination. The subject was hospitalised with good clinical evolution. No further information was available in the clinical file. On 24 March 2008 the subject received 2nd dose of Rotarix (oral). On 24 March 2008, less than one day after vaccination with Rotarix, the subject started vomiting and he had one stool like current jelly stool. The subject was treated with paracetamol and cisapride without improvement. On 25 March 2008 the subject was admitted at the emergency room with still vomiting and hematochezia. At physical examination the subject presented increasing bowel sounds and intense crying at abdominal palpation without evidence of respiratory process. Relevant test included abdominal x-ray which showed evidence of air fluid levels and lack of air in distal area. The barium enema showed invagination in ascendant colon in the first image, after that, it passed contrast medium until distal ileum successfully. The subject''s clinical evolution was favorable. On 27 March 2008 the subject was discharged in good clinical conditions. The subject was treated with Ketorolac, amikacin, ceftriaxone, nalbuphine and enema. The physician considered the events were possibly related to vaccination with Rotarix.


Changed on 2/14/2018

VAERS ID: 311430 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Foreign
Vaccinated:2008-03-24
Onset:2008-03-24
Submitted:2008-05-02
Entered:2008-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Blood chloride increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Crying, Haematochezia, Haematocrit normal, Haemoglobin normal, Intussusception, Platelet count decreased, Vomiting, White blood cell count increased, Neutrophil percentage increased, Abdominal X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: BRONCHIOLITIS
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 25Mar2008, see textunit; Blood glucose, 25Mar2008, 113mg/dl; Chloride, 25Mar2008, 110mEq/L; Creatinine, 25Mar2008, 0.4mg/dl; Hematocrit, 25Mar2008, 33.05%; Hemoglobin, 25Mar2008, 10.83g/dl; Leukocyte count NOS, 25Mar2008, 25140mm3; Neutrophils, 25Mar2008, 78.3%; Platelet count, 25Mar2008, 244800mm3; Potassium, 25Mar2008, 4.4mEq/L; Sodium, 25Mar2008, 143mEq/L
CDC 'Split Type': B0517772A

Write-up: This case was reported by a physician in the frame of a study 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 24 March 2008; Rotarix; GlaxoSmithKline; oral given on 8 January 2008. The subject''s medical history included bronchiolitis which occurred 3 weeks previous vaccination. The subject was hospitalised with good clinical evolution. No further information was available in the clinical file. On 24 March 2008 the subject received 2nd dose of Rotarix (oral). On 24 March 2008, less than one day after vaccination with Rotarix, the subject started vomiting and he had one stool like current jelly stool. The subject was treated with paracetamol and cisapride without improvement. On 25 March 2008 the subject was admitted at the emergency room with still vomiting and hematochezia. At physical examination the subject presented increasing bowel sounds and intense crying at abdominal palpation without evidence of respiratory process. Relevant test included abdominal x-ray which showed evidence of air fluid levels and lack of air in distal area. The barium enema showed invagination in ascendant colon in the first image, after that, it passed contrast medium until distal ileum successfully. The subject''s clinical evolution was favorable. On 27 March 2008 the subject was discharged in good clinical conditions. The subject was treated with Ketorolac, amikacin, ceftriaxone, nalbuphine and enema. The physician considered the events were possibly related to vaccination with Rotarix.


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