National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 316966

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 316966
VAERS Form:
Age:0.2
Gender:Male
Location:Foreign
Vaccinated:2008-03-27
Onset:2008-04-03
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Breast feeding, Intestinal obstruction, Intussusception, Irritability, Lethargy, Pallor, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Intestinal resection, Abdominal X-ray, Rotavirus test positive, Familial risk factor, Gastrointestinal sounds abnormal

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:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, Apr2008, Fluid level; Rotavirus test, 06Apr2008, Positive; Ultrasound abdomen, Apr2008, IS
CDC 'Split Type': B0525608A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 2-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 is 4.22 Kg. The subject had no history of intussusception. The subject had no previous significant illness/ hospitalisations/ operations. The subject had a family history of intussusception. Feeding history: The subject currently fed breast milk and formula. There was no change to the subject''s diet in the last week. The subject had no feeding intolerance or food sensitivities. The subject received current medications or traditional medicines. Previous and/or concurrent vaccination included Hib (manufacturer unspecified; unknown) given on an unspecified date; DTaP (manufacturer unspecified; unknown) given on an unspecified date; Hep B (manufacturer unspecified; unknown) given on an unspecified date; pneumococcal vaccine, unspecified (manufacturer unspecified; unknown0 given on an unspecified date. On 27 March 2008, the subject received the 1st dose of ROTARIX (unknown). On 3 April 2008, 7 days after vaccination with ROTARIX, the subject experienced intussusception; He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal obstruction; acute abdominal distention and abnormal or absent bowel sounds. Abdominal X-ray showed fluid level. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS: Hepatic flexure; Type of IS: ileocaecal). On 06 April 2008, faeces''s sample was collected; RNA Rotavirus test was positive. The subject required surgical resection. This case was assessed as medically serious by GSK. At the time of reporting the outcome of the events was unspecified.


Changed on 5/13/2013

VAERS ID: 316966 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Foreign
Vaccinated:2008-03-27
Onset:2008-04-03
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Breast feeding, Intestinal obstruction, Intussusception, Irritability, Lethargy, Pallor, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Intestinal resection, Abdominal X-ray, Rotavirus test positive, Familial risk factor, Gastrointestinal sounds abnormal

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:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, Apr2008, Fluid level; Rotavirus test, 06Apr2008, Positive; Ultrasound abdomen, Apr2008, IS
CDC 'Split Type': B0525608A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 2-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 is 4.22 Kg. The subject had no history of intussusception. The subject had no previous significant illness/ hospitalisations/ operations. The subject had a family history of intussusception. Feeding history: The subject currently fed breast milk and formula. There was no change to the subject''s diet in the last week. The subject had no feeding intolerance or food sensitivities. The subject received current medications or traditional medicines. Previous and/or concurrent vaccination included Hib (manufacturer unspecified; unknown) given on an unspecified date; DTaP (manufacturer unspecified; unknown) given on an unspecified date; Hep B (manufacturer unspecified; unknown) given on an unspecified date; pneumococcal vaccine, unspecified (manufacturer unspecified; unknown0 given on an unspecified date. On 27 March 2008, the subject received the 1st dose of ROTARIX (unknown). On 3 April 2008, 7 days after vaccination with ROTARIX, the subject experienced intussusception; He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal obstruction; acute abdominal distention and abnormal or absent bowel sounds. Abdominal X-ray showed fluid level. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS: Hepatic flexure; Type of IS: ileocaecal). On 06 April 2008, faeces''s sample was collected; RNA Rotavirus test was positive. The subject required surgical resection. This case was assessed as medically serious by GSK. At the time of reporting the outcome of the events was unspecified.


Changed on 9/14/2017

VAERS ID: 316966 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Foreign
Vaccinated:2008-03-27
Onset:2008-04-03
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Breast feeding, Intestinal obstruction, Intussusception, Irritability, Lethargy, Pallor, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Intestinal resection, Abdominal X-ray, Rotavirus test positive, Familial risk factor, Gastrointestinal sounds abnormal

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:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, Apr2008, Fluid level; Rotavirus test, 06Apr2008, Positive; Ultrasound abdomen, Apr2008, IS
CDC 'Split Type': B0525608A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 2-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 is 4.22 Kg. The subject had no history of intussusception. The subject had no previous significant illness/ hospitalisations/ operations. The subject had a family history of intussusception. Feeding history: The subject currently fed breast milk and formula. There was no change to the subject''s diet in the last week. The subject had no feeding intolerance or food sensitivities. The subject received current medications or traditional medicines. Previous and/or concurrent vaccination included Hib (manufacturer unspecified; unknown) given on an unspecified date; DTaP (manufacturer unspecified; unknown) given on an unspecified date; Hep B (manufacturer unspecified; unknown) given on an unspecified date; pneumococcal vaccine, unspecified (manufacturer unspecified; unknown0 given on an unspecified date. On 27 March 2008, the subject received the 1st dose of ROTARIX (unknown). On 3 April 2008, 7 days after vaccination with ROTARIX, the subject experienced intussusception; He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal obstruction; acute abdominal distention and abnormal or absent bowel sounds. Abdominal X-ray showed fluid level. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS: Hepatic flexure; Type of IS: ileocaecal). On 06 April 2008, faeces''s sample was collected; RNA Rotavirus test was positive. The subject required surgical resection. This case was assessed as medically serious by GSK. At the time of reporting the outcome of the events was unspecified.


Changed on 2/14/2018

VAERS ID: 316966 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Foreign
Vaccinated:2008-03-27
Onset:2008-04-03
Submitted:2008-06-23
Entered:2008-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Breast feeding, Intestinal obstruction, Intussusception, Irritability, Lethargy, Pallor, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Intestinal resection, Abdominal X-ray, Rotavirus test positive, Familial risk factor, Gastrointestinal sounds abnormal

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:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, Apr2008, Fluid level; Rotavirus test, 06Apr2008, Positive; Ultrasound abdomen, Apr2008, IS
CDC 'Split Type': B0525608A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 2-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 is 4.22 Kg. The subject had no history of intussusception. The subject had no previous significant illness/ hospitalisations/ operations. The subject had a family history of intussusception. Feeding history: The subject currently fed breast milk and formula. There was no change to the subject''s diet in the last week. The subject had no feeding intolerance or food sensitivities. The subject received current medications or traditional medicines. Previous and/or concurrent vaccination included Hib (manufacturer unspecified; unknown) given on an unspecified date; DTaP (manufacturer unspecified; unknown) given on an unspecified date; Hep B (manufacturer unspecified; unknown) given on an unspecified date; pneumococcal vaccine, unspecified (manufacturer unspecified; unknown0 given on an unspecified date. On 27 March 2008, the subject received the 1st dose of ROTARIX (unknown). On 3 April 2008, 7 days after vaccination with ROTARIX, the subject experienced intussusception; He experienced the following symptoms: abdominal pain, vomiting, lethargy, pallor, irritability, intestinal obstruction; acute abdominal distention and abnormal or absent bowel sounds. Abdominal X-ray showed fluid level. The diagnosis of intussusception was made based on abdominal ultrasound exam (site of IS: Hepatic flexure; Type of IS: ileocaecal). On 06 April 2008, faeces''s sample was collected; RNA Rotavirus test was positive. The subject required surgical resection. This case was assessed as medically serious by GSK. At the time of reporting the outcome of the events was unspecified.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=316966&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166