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This is VAERS ID 314408

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 314408
VAERS Form:
Age:5.0
Gender:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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': B0522166A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 5-year-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date, the subject received 2nd dose of ROTARIX (oral), lot number not provided. In May 2008, at an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. At the time of reporting the event was unresolved.


Changed on 5/13/2013

VAERS ID: 314408 Before After
VAERS Form:
Age:5.0
Gender:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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': B0522166A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 5-year-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date, the subject received 2nd dose of ROTARIX (oral), lot number not provided. In May 2008, at an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. At the time of reporting the event was unresolved.


Changed on 9/14/2017

VAERS ID: 314408 Before After
VAERS Form:(blank) 1
Age:5.0
Gender:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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': B0522166A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 5-year-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date, the subject received 2nd dose of ROTARIX (oral), lot number not provided. In May 2008, at an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. At the time of reporting the event was unresolved.


Changed on 2/14/2018

VAERS ID: 314408 Before After
VAERS Form:1
Age:5.0
Gender:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2008-05-01
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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': B0522166A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 5-year-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date, the subject received 2nd dose of ROTARIX (oral), lot number not provided. In May 2008, at an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. At the time of reporting the event was unresolved.


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