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This is VAERS ID 312637

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 312637
VAERS Form:
Age:
Gender:Unknown
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-20
Entered:2008-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal resection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0520205A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a child subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). This case has been reported to foreign regulatory authorities. The reporter stated that the child''s parent had a previous history of intussusception. On an unspecified date the subject received unspecified dose of ROTARIX (unknown). In May 2008, within 8 days of vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. The subject required bowel resection and remained in hospital. At the time of reporting the outcome of the event was unspecified. The reporter was not the treating physician and any attempts to request further information on this case would require consent from the patient.


Changed on 5/13/2013

VAERS ID: 312637 Before After
VAERS Form:
Age:
Gender:Unknown
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-20
Entered:2008-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal resection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0520205A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a child subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). This case has been reported to foreign regulatory authorities. The reporter stated that the child''s parent had a previous history of intussusception. On an unspecified date the subject received unspecified dose of ROTARIX (unknown). In May 2008, within 8 days of vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. The subject required bowel resection and remained in hospital. At the time of reporting the outcome of the event was unspecified. The reporter was not the treating physician and any attempts to request further information on this case would require consent from the patient.


Changed on 9/14/2017

VAERS ID: 312637 Before After
VAERS Form:(blank) 1
Age:
Gender:Unknown
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-20
Entered:2008-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal resection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0520205A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a child subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). This case has been reported to foreign regulatory authorities. The reporter stated that the child''s parent had a previous history of intussusception. On an unspecified date the subject received unspecified dose of ROTARIX (unknown). In May 2008, within 8 days of vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. The subject required bowel resection and remained in hospital. At the time of reporting the outcome of the event was unspecified. The reporter was not the treating physician and any attempts to request further information on this case would require consent from the patient.


Changed on 2/14/2018

VAERS ID: 312637 Before After
VAERS Form:1
Age:
Gender:Unknown
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-20
Entered:2008-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal resection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0520205A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a child subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). This case has been reported to foreign regulatory authorities. The reporter stated that the child''s parent had a previous history of intussusception. On an unspecified date the subject received unspecified dose of ROTARIX (unknown). In May 2008, within 8 days of vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. The subject required bowel resection and remained in hospital. At the time of reporting the outcome of the event was unspecified. The reporter was not the treating physician and any attempts to request further information on this case would require consent from the patient.


Changed on 6/14/2018

VAERS ID: 312637 Before After
VAERS Form:1
Age:
Gender:Unknown
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-20
Entered:2008-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal resection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0520205A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a child subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). This case has been reported to foreign regulatory authorities. The reporter stated that the child''s parent had a previous history of intussusception. On an unspecified date the subject received unspecified dose of ROTARIX (unknown). In May 2008, within 8 days of vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. The subject required bowel resection and remained in hospital. At the time of reporting the outcome of the event was unspecified. The reporter was not the treating physician and any attempts to request further information on this case would require consent from the patient.

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=312637&WAYBACKHISTORY=ON


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