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This is VAERS ID 315306

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 315306
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-29
Onset:2008-05-17
Submitted:2008-06-06
Entered:2008-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, CD4 lymphocytes decreased, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Neutrophil count increased, Platelet count normal, Prothrombin time normal, Pyrexia, Rectal haemorrhage, Surgery, White blood cell count increased, Lymphocyte percentage decreased

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema, 17May2008, intussuscept unit; Blood grouping, 17May2008, ORh+unit; Hematocrit, 17May2008, 31.4%, 38 (low), 47 (high); Hemoglobin, 17May2008, 9.43g/dl, 12 (low), 16 (high); Lymphocytes, 17May2008, 15%, 20 (low), 48 (high); Neut
CDC 'Split Type': B0522871A

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. The subject was under no other medication and had no relevant medical history nor allergy. On 29 April 2008, the subject received 1st dose of ROTARIX (oral), lot number not provided. On 17 May 2008, 18 days after vaccination with ROTARIX, the subject experienced bloody stools like current jelly stool. He was brought to the emergency ward. The physical examination showed fever and rectal bleeding with an abdomen without other clinical sign. Barium enema was performed and confirmed intussusception. On 17 May 2008, surgery was performed and ileocolic intussusception was found and reduced by taxis without complication. The subject was hospitalised for 4 days. The subject was treated with ranitidine hydrochloride, ampicillin sodium, paracetamol, ampicillin trihydrate and vitamin k. On 20 May 2008, the events were resolved and the subject was discharged from hospital. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 5/13/2013

VAERS ID: 315306 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-29
Onset:2008-05-17
Submitted:2008-06-06
Entered:2008-06-06
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: Barium enema abnormal, CD4 lymphocytes decreased, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Neutrophil count increased, Platelet count normal, Prothrombin time normal, Pyrexia, Rectal haemorrhage, Surgery, White blood cell count increased, Lymphocyte percentage decreased

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema, 17May2008, intussuscept unit; Blood grouping, 17May2008, ORh+unit; Hematocrit, 17May2008, 31.4%, 38 (low), 47 (high); Hemoglobin, 17May2008, 9.43g/dl, 12 (low), 16 (high); Lymphocytes, 17May2008, 15%, 20 (low), 48 (high); Neut
CDC 'Split Type': B0522871A

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. The subject was under no other medication and had no relevant medical history nor allergy. On 29 April 2008, the subject received 1st dose of ROTARIX (oral), lot number not provided. On 17 May 2008, 18 days after vaccination with ROTARIX, the subject experienced bloody stools like current jelly stool. He was brought to the emergency ward. The physical examination showed fever and rectal bleeding with an abdomen without other clinical sign. Barium enema was performed and confirmed intussusception. On 17 May 2008, surgery was performed and ileocolic intussusception was found and reduced by taxis without complication. The subject was hospitalised for 4 days. The subject was treated with ranitidine hydrochloride, ampicillin sodium, paracetamol, ampicillin trihydrate and vitamin k. On 20 May 2008, the events were resolved and the subject was discharged from hospital. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 4/14/2017

VAERS ID: 315306 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-29
Onset:2008-05-17
Submitted:2008-06-06
Entered:2008-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, CD4 lymphocytes decreased, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Neutrophil count increased, Platelet count normal, Prothrombin time normal, Pyrexia, Rectal haemorrhage, Surgery, White blood cell count increased, Lymphocyte percentage decreased

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema, 17May2008, intussuscept unit; Blood grouping, 17May2008, ORh+unit; Hematocrit, 17May2008, 31.4%, 38 (low), 47 (high); Hemoglobin, 17May2008, 9.43g/dl, 12 (low), 16 (high); Lymphocytes, 17May2008, 15%, 20 (low), 48 (high); Neut Neutrophils, 17May2008, 75%, 40 (low), 70 (high); Platelet count, 17May2008, 354000/mm3, 150000 (low), 450000 (high); Prothrombin time, 17May2008, 11.9 sec, 10.5 (low), 14.5 (high); White blood cells, 17May2008, 18600/mm3, 4500 (low), 10000 (high).
CDC 'Split Type': B0522871A

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. The subject was under no other medication and had no relevant medical history nor allergy. On 29 April 2008, the subject received 1st dose of ROTARIX (oral), lot number not provided. On 17 May 2008, 18 days after vaccination with ROTARIX, the subject experienced bloody stools like current jelly stool. He was brought to the emergency ward. The physical examination showed fever and rectal bleeding with an abdomen without other clinical sign. Barium enema was performed and confirmed intussusception. On 17 May 2008, surgery was performed and ileocolic intussusception was found and reduced by taxis without complication. The subject was hospitalised for 4 days. The subject was treated with ranitidine hydrochloride, ampicillin sodium, paracetamol, ampicillin trihydrate and vitamin k. On 20 May 2008, the events were resolved and the subject was discharged from hospital. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 9/14/2017

VAERS ID: 315306 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-29
Onset:2008-05-17
Submitted:2008-06-06
Entered:2008-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, CD4 lymphocytes decreased, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Neutrophil count increased, Platelet count normal, Prothrombin time normal, Pyrexia, Rectal haemorrhage, Surgery, White blood cell count increased, Lymphocyte percentage decreased

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema, 17May2008, intussuscept unit; Blood grouping, 17May2008, ORh+unit; Hematocrit, 17May2008, 31.4%, 38 (low), 47 (high); Hemoglobin, 17May2008, 9.43g/dl, 12 (low), 16 (high); Lymphocytes, 17May2008, 15%, 20 (low), 48 (high); Neutrophils, 17May2008, 75%, 40 (low), 70 (high); Platelet count, 17May2008, 354000/mm3, 150000 (low), 450000 (high); Prothrombin time, 17May2008, 11.9 sec, 10.5 (low), 14.5 (high); White blood cells, 17May2008, 18600/mm3, 4500 (low), 10000 (high).
CDC 'Split Type': B0522871A

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. The subject was under no other medication and had no relevant medical history nor allergy. On 29 April 2008, the subject received 1st dose of ROTARIX (oral), lot number not provided. On 17 May 2008, 18 days after vaccination with ROTARIX, the subject experienced bloody stools like current jelly stool. He was brought to the emergency ward. The physical examination showed fever and rectal bleeding with an abdomen without other clinical sign. Barium enema was performed and confirmed intussusception. On 17 May 2008, surgery was performed and ileocolic intussusception was found and reduced by taxis without complication. The subject was hospitalised for 4 days. The subject was treated with ranitidine hydrochloride, ampicillin sodium, paracetamol, ampicillin trihydrate and vitamin k. On 20 May 2008, the events were resolved and the subject was discharged from hospital. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 2/14/2018

VAERS ID: 315306 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-29
Onset:2008-05-17
Submitted:2008-06-06
Entered:2008-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, CD4 lymphocytes decreased, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Neutrophil count increased, Platelet count normal, Prothrombin time normal, Pyrexia, Rectal haemorrhage, Surgery, White blood cell count increased, Lymphocyte percentage decreased

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema, 17May2008, intussuscept unit; Blood grouping, 17May2008, ORh+unit; Hematocrit, 17May2008, 31.4%, 38 (low), 47 (high); Hemoglobin, 17May2008, 9.43g/dl, 12 (low), 16 (high); Lymphocytes, 17May2008, 15%, 20 (low), 48 (high); Neutrophils, 17May2008, 75%, 40 (low), 70 (high); Platelet count, 17May2008, 354000/mm3, 150000 (low), 450000 (high); Prothrombin time, 17May2008, 11.9 sec, 10.5 (low), 14.5 (high); White blood cells, 17May2008, 18600/mm3, 4500 (low), 10000 (high).
CDC 'Split Type': B0522871A

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. The subject was under no other medication and had no relevant medical history nor allergy. On 29 April 2008, the subject received 1st dose of ROTARIX (oral), lot number not provided. On 17 May 2008, 18 days after vaccination with ROTARIX, the subject experienced bloody stools like current jelly stool. He was brought to the emergency ward. The physical examination showed fever and rectal bleeding with an abdomen without other clinical sign. Barium enema was performed and confirmed intussusception. On 17 May 2008, surgery was performed and ileocolic intussusception was found and reduced by taxis without complication. The subject was hospitalised for 4 days. The subject was treated with ranitidine hydrochloride, ampicillin sodium, paracetamol, ampicillin trihydrate and vitamin k. On 20 May 2008, the events were resolved and the subject was discharged from hospital. The physician considered the events were possibly related to vaccination with ROTARIX.


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