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This is VAERS ID 314412

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 314412
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2008-02-08
Onset:2008-02-13
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': D0057465A

Write-up: This three-month-old female subject was enrolled in a epidemiological study to gather epidemiological back-ground data on the incidence of intussusception. The subject received oral ROTARIX on 08 February 2008. On 13 February 2008, five days after vaccination with ROTARIX, this three-month-old subject developed intussusception. The subject was hospitalised for 2 days. The disease took an uncomplicated course. The event resolved on 14 February 2008 and the subject was discharged after successful reposition. Investigator causality was unknown at the time of reporting. Follow-up information has been requested.


Changed on 5/13/2013

VAERS ID: 314412 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2008-02-08
Onset:2008-02-13
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': D0057465A

Write-up: This three-month-old female subject was enrolled in a epidemiological study to gather epidemiological back-ground data on the incidence of intussusception. The subject received oral ROTARIX on 08 February 2008. On 13 February 2008, five days after vaccination with ROTARIX, this three-month-old subject developed intussusception. The subject was hospitalised for 2 days. The disease took an uncomplicated course. The event resolved on 14 February 2008 and the subject was discharged after successful reposition. Investigator causality was unknown at the time of reporting. Follow-up information has been requested.


Changed on 9/14/2017

VAERS ID: 314412 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2008-02-08
Onset:2008-02-13
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': D0057465A

Write-up: This three-month-old female subject was enrolled in a epidemiological study to gather epidemiological back-ground data on the incidence of intussusception. The subject received oral ROTARIX on 08 February 2008. On 13 February 2008, five days after vaccination with ROTARIX, this three-month-old subject developed intussusception. The subject was hospitalised for 2 days. The disease took an uncomplicated course. The event resolved on 14 February 2008 and the subject was discharged after successful reposition. Investigator causality was unknown at the time of reporting. Follow-up information has been requested.


Changed on 2/14/2018

VAERS ID: 314412 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2008-02-08
Onset:2008-02-13
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': D0057465A

Write-up: This three-month-old female subject was enrolled in a epidemiological study to gather epidemiological back-ground data on the incidence of intussusception. The subject received oral ROTARIX on 08 February 2008. On 13 February 2008, five days after vaccination with ROTARIX, this three-month-old subject developed intussusception. The subject was hospitalised for 2 days. The disease took an uncomplicated course. The event resolved on 14 February 2008 and the subject was discharged after successful reposition. Investigator causality was unknown at the time of reporting. Follow-up information has been requested.


Changed on 6/14/2018

VAERS ID: 314412 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2008-02-08
Onset:2008-02-13
Submitted:2008-05-30
Entered:2008-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': D0057465A

Write-up: This three-month-old female subject was enrolled in a epidemiological study to gather epidemiological back-ground data on the incidence of intussusception. The subject received oral ROTARIX on 08 February 2008. On 13 February 2008, five days after vaccination with ROTARIX, this three-month-old subject developed intussusception. The subject was hospitalised for 2 days. The disease took an uncomplicated course. The event resolved on 14 February 2008 and the subject was discharged after successful reposition. Investigator causality was unknown at the time of reporting. Follow-up information has been requested.

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