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This is VAERS ID 317781

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

317781
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-05-19
Onset:2008-06-12
Submitted:2008-06-27
Entered:2008-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Abdominal pain, Anorexia, Appendicectomy, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood thromboplastin normal, Blood urea normal, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pallor, Prothrombin time normal, Somnolence, Surgery, Vomiting, White blood cell count normal, Platelet count increased, Neutrophil percentage decreased, Decreased appetite, Gastrointestinal sounds abnormal

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: Blood glucose, 12Jun2008, 96mg/dl; Blood urea nitrogen, 12Jun2008, 13mg/dl; Chloride, 12Jun2008, 98mmol/l; Creatinine, 12Jun2008, 0.4mg/dl; Hematocrit, 12Jun2008, 30.3%; Hemoglobin, 12Jun2008, 7.7g/dl; Neutrophil percentage, 12Jun2008, 44.7
CDC 'Split Type': B0526159A

Write-up:On 19 May 2008, she received the first dose of ROTARIX. This case was reported by a physician in the frame of a study and described the occurrence of ileocolic intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history or allergy. On 19 May 2008, the subject received the 1st dose of ROTARIX (oral, lot number not provided). On 12 June 2008, 24 days after vaccination with the 1st dose of ROTARIX, the subject experienced vomiting (6 episodes/24 hours), hyporexia, bloody stools (2 episodes/24 hours) and one episode of vomiting with bilious. On the same day she was taken to ER. On 12 June 2008, the subject was hospitalised. Physical exam reported somnolence, mild dehydration, painful abdominal mass in the right side, increased peristalsis and jelly-red stools during rectal examination with mild pallor. Lab tests were performed. On 13 June 2008 surgery was done; Ileocolic intussusception was resolved by taxis without complications and prophylactic appendectomy was performed. She had clinical improvement and was discharged on 16 June 2008 in good clinical conditions. The subject was treated with ampicillin, amikacin and paracetamol. On 16 June 2008, the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 5/13/2013

317781 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-05-19
Onset:2008-06-12
Submitted:2008-06-27
Entered:2008-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Abdominal pain, Anorexia, Appendicectomy, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood thromboplastin normal, Blood urea normal, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pallor, Prothrombin time normal, Somnolence, Surgery, Vomiting, White blood cell count normal, Platelet count increased, Neutrophil percentage decreased, Decreased appetite, Gastrointestinal sounds abnormal

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: Blood glucose, 12Jun2008, 96mg/dl; Blood urea nitrogen, 12Jun2008, 13mg/dl; Chloride, 12Jun2008, 98mmol/l; Creatinine, 12Jun2008, 0.4mg/dl; Hematocrit, 12Jun2008, 30.3%; Hemoglobin, 12Jun2008, 7.7g/dl; Neutrophil percentage, 12Jun2008, 44.7
CDC 'Split Type': B0526159A

Write-up:On 19 May 2008, she received the first dose of ROTARIX. This case was reported by a physician in the frame of a study and described the occurrence of ileocolic intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history or allergy. On 19 May 2008, the subject received the 1st dose of ROTARIX (oral, lot number not provided). On 12 June 2008, 24 days after vaccination with the 1st dose of ROTARIX, the subject experienced vomiting (6 episodes/24 hours), hyporexia, bloody stools (2 episodes/24 hours) and one episode of vomiting with bilious. On the same day she was taken to ER. On 12 June 2008, the subject was hospitalised. Physical exam reported somnolence, mild dehydration, painful abdominal mass in the right side, increased peristalsis and jelly-red stools during rectal examination with mild pallor. Lab tests were performed. On 13 June 2008 surgery was done; Ileocolic intussusception was resolved by taxis without complications and prophylactic appendectomy was performed. She had clinical improvement and was discharged on 16 June 2008 in good clinical conditions. The subject was treated with ampicillin, amikacin and paracetamol. On 16 June 2008, the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 4/14/2017

317781 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-05-19
Onset:2008-06-12
Submitted:2008-06-27
Entered:2008-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Abdominal pain, Anorexia, Appendicectomy, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood thromboplastin normal, Blood urea normal, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pallor, Prothrombin time normal, Somnolence, Surgery, Vomiting, White blood cell count normal, Platelet count increased, Neutrophil percentage decreased, Decreased appetite, Gastrointestinal sounds abnormal

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: Blood glucose, 12Jun2008, 96mg/dl; Blood urea nitrogen, 12Jun2008, 13mg/dl; Chloride, 12Jun2008, 98mmol/l; Creatinine, 12Jun2008, 0.4mg/dl; Hematocrit, 12Jun2008, 30.3%; Hemoglobin, 12Jun2008, 7.7g/dl; Neutrophil percentage, 12Jun2008, 44.7 44.7%; Platelet count, 12Jun2008, 716,000/mm3; Potassium, 12Jun2008, 4.4mmol/l; Prothrombin time, 12Jun2008, 11.5sec; Sodium, 12Jun2008, 135mmol/l; Thromboplastin, 12Jun2008, 30.6sec; White blood cells, 12Jun2008, 7,000/mm3
CDC 'Split Type': B0526159A

Write-up:On 19 May 2008, she received the first dose of ROTARIX. This case was reported by a physician in the frame of a study and described the occurrence of ileocolic intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history or allergy. On 19 May 2008, the subject received the 1st dose of ROTARIX (oral, lot number not provided). On 12 June 2008, 24 days after vaccination with the 1st dose of ROTARIX, the subject experienced vomiting (6 episodes/24 hours), hyporexia, bloody stools (2 episodes/24 hours) and one episode of vomiting with bilious. On the same day she was taken to ER. On 12 June 2008, the subject was hospitalised. Physical exam reported somnolence, mild dehydration, painful abdominal mass in the right side, increased peristalsis and jelly-red stools during rectal examination with mild pallor. Lab tests were performed. On 13 June 2008 surgery was done; Ileocolic intussusception was resolved by taxis without complications and prophylactic appendectomy was performed. She had clinical improvement and was discharged on 16 June 2008 in good clinical conditions. The subject was treated with ampicillin, amikacin and paracetamol. On 16 June 2008, the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 9/14/2017

317781 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-05-19
Onset:2008-06-12
Submitted:2008-06-27
Entered:2008-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Abdominal pain, Anorexia, Appendicectomy, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood thromboplastin normal, Blood urea normal, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pallor, Prothrombin time normal, Somnolence, Surgery, Vomiting, White blood cell count normal, Platelet count increased, Neutrophil percentage decreased, Decreased appetite, Gastrointestinal sounds abnormal

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: Blood glucose, 12Jun2008, 96mg/dl; Blood urea nitrogen, 12Jun2008, 13mg/dl; Chloride, 12Jun2008, 98mmol/l; Creatinine, 12Jun2008, 0.4mg/dl; Hematocrit, 12Jun2008, 30.3%; Hemoglobin, 12Jun2008, 7.7g/dl; Neutrophil percentage, 12Jun2008, 44.7%; Platelet count, 12Jun2008, 716,000/mm3; Potassium, 12Jun2008, 4.4mmol/l; Prothrombin time, 12Jun2008, 11.5sec; Sodium, 12Jun2008, 135mmol/l; Thromboplastin, 12Jun2008, 30.6sec; White blood cells, 12Jun2008, 7,000/mm3
CDC 'Split Type': B0526159A

Write-up:On 19 May 2008, she received the first dose of ROTARIX. This case was reported by a physician in the frame of a study and described the occurrence of ileocolic intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history or allergy. On 19 May 2008, the subject received the 1st dose of ROTARIX (oral, lot number not provided). On 12 June 2008, 24 days after vaccination with the 1st dose of ROTARIX, the subject experienced vomiting (6 episodes/24 hours), hyporexia, bloody stools (2 episodes/24 hours) and one episode of vomiting with bilious. On the same day she was taken to ER. On 12 June 2008, the subject was hospitalised. Physical exam reported somnolence, mild dehydration, painful abdominal mass in the right side, increased peristalsis and jelly-red stools during rectal examination with mild pallor. Lab tests were performed. On 13 June 2008 surgery was done; Ileocolic intussusception was resolved by taxis without complications and prophylactic appendectomy was performed. She had clinical improvement and was discharged on 16 June 2008 in good clinical conditions. The subject was treated with ampicillin, amikacin and paracetamol. On 16 June 2008, the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


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