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This is VAERS ID 316965

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 316965
VAERS Form:
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.


Changed on 5/13/2013

VAERS ID: 316965 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.


Changed on 9/14/2017

VAERS ID: 316965 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.


Changed on 2/14/2018

VAERS ID: 316965 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.


Changed on 6/14/2018

VAERS ID: 316965 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.


Changed on 8/14/2018

VAERS ID: 316965 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.


Changed on 9/14/2018

VAERS ID: 316965 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-27
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Breast feeding, Intussusception, Irritability, Lethargy, Pallor, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Intestinal resection, Intestinal mass

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Ultrasound abdomen, Feb2008, IS
CDC 'Split Type': B0525609A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 7-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). This case is one of 4 cases collected through a study occurring post ROTARIX vaccination since August 2007. The subject was born at term. The subject''s birth weight was 2.6 Kg. The subject''s medical history included gastroesophageal reflux. The subject had no history of intussusception. The subject had no family history of intussusception. The subject had no current medications or traditional medicines. Feeding history: The subject currently fed breast milk. There was no change to the subject''s diet in the last week. The subject had feeding intolerance/food sensitivities (gastroesophageal reflux disease). Previous vaccination included ROTARIX (GlaxoSmithKline; unknown) given on 19 October 2007. On 30 January 2008, the subject received 2nd dose of ROTARIX (unknown). On 27 February 2008, 28 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal mass and passage of blood per rectum. No faeces''s sample was collected. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS; ascending colon). The subject was treated with air/hydrostatic Enema. Surgical resection was performed. The lead point or other pathology have not been identified. This case was assessed as medically serious by GSK. On 03 March 2008, the subject was discharged. At the time of reporting the outcome of the events was unspecified.

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