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This is VAERS ID 322489

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 322489
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2007-11-22
Onset:2008-01-03
Submitted:2008-08-18
Entered:2008-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Enteritis, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533335A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; Hep B (manufacturer unspecified, intramuscular) given on 20 September 2007, 22 November 2007 and 22 March 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 January 2007, pneumococcal vaccine (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 20 September 2007. On 22 November 2007, the subject received 1st dose of ROTARIX (1 ml, oral). Lot number not provided. On 3 January 2008, 42 days after vaccination with ROTARIX, the subject was taken to ER, with colicky abdominal pain and 2 evacuations without mucus or blood with initial diagnosis of acute enteritis. After evaluation, intestinal intussusception was diagnosed. The surgery was done on 3 January 2008 and showed ileo-colic intussusception resolved by taxis without resection and complication. The subject had good response and favorable evolution. The subject was hospitalized and the physician considered the events were clinically significant (or requiring intervention). The physician did not have any data about diagnostic procedure. No abdominal X-ray or ultrasound was performed. On 6 January 2008, the events were resolved by surgery and the patient was discharged. After the next vaccination with ROTARIX the events did not recur. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 5/13/2013

VAERS ID: 322489 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2007-11-22
Onset:2008-01-03
Submitted:2008-08-18
Entered:2008-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Enteritis, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533335A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; Hep B (manufacturer unspecified, intramuscular) given on 20 September 2007, 22 November 2007 and 22 March 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 January 2007, pneumococcal vaccine (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 20 September 2007. On 22 November 2007, the subject received 1st dose of ROTARIX (1 ml, oral). Lot number not provided. On 3 January 2008, 42 days after vaccination with ROTARIX, the subject was taken to ER, with colicky abdominal pain and 2 evacuations without mucus or blood with initial diagnosis of acute enteritis. After evaluation, intestinal intussusception was diagnosed. The surgery was done on 3 January 2008 and showed ileo-colic intussusception resolved by taxis without resection and complication. The subject had good response and favorable evolution. The subject was hospitalized and the physician considered the events were clinically significant (or requiring intervention). The physician did not have any data about diagnostic procedure. No abdominal X-ray or ultrasound was performed. On 6 January 2008, the events were resolved by surgery and the patient was discharged. After the next vaccination with ROTARIX the events did not recur. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 9/14/2017

VAERS ID: 322489 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2007-11-22
Onset:2008-01-03
Submitted:2008-08-18
Entered:2008-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Enteritis, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533335A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; Hep B (manufacturer unspecified, intramuscular) given on 20 September 2007, 22 November 2007 and 22 March 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 January 2007, pneumococcal vaccine (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 20 September 2007. On 22 November 2007, the subject received 1st dose of ROTARIX (1 ml, oral). Lot number not provided. On 3 January 2008, 42 days after vaccination with ROTARIX, the subject was taken to ER, with colicky abdominal pain and 2 evacuations without mucus or blood with initial diagnosis of acute enteritis. After evaluation, intestinal intussusception was diagnosed. The surgery was done on 3 January 2008 and showed ileo-colic intussusception resolved by taxis without resection and complication. The subject had good response and favorable evolution. The subject was hospitalized and the physician considered the events were clinically significant (or requiring intervention). The physician did not have any data about diagnostic procedure. No abdominal X-ray or ultrasound was performed. On 6 January 2008, the events were resolved by surgery and the patient was discharged. After the next vaccination with ROTARIX the events did not recur. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 2/14/2018

VAERS ID: 322489 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2007-11-22
Onset:2008-01-03
Submitted:2008-08-18
Entered:2008-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Enteritis, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533335A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; Hep B (manufacturer unspecified, intramuscular) given on 20 September 2007, 22 November 2007 and 22 March 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 January 2007, pneumococcal vaccine (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 20 September 2007. On 22 November 2007, the subject received 1st dose of ROTARIX (1 ml, oral). Lot number not provided. On 3 January 2008, 42 days after vaccination with ROTARIX, the subject was taken to ER, with colicky abdominal pain and 2 evacuations without mucus or blood with initial diagnosis of acute enteritis. After evaluation, intestinal intussusception was diagnosed. The surgery was done on 3 January 2008 and showed ileo-colic intussusception resolved by taxis without resection and complication. The subject had good response and favorable evolution. The subject was hospitalized and the physician considered the events were clinically significant (or requiring intervention). The physician did not have any data about diagnostic procedure. No abdominal X-ray or ultrasound was performed. On 6 January 2008, the events were resolved by surgery and the patient was discharged. After the next vaccination with ROTARIX the events did not recur. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 6/14/2018

VAERS ID: 322489 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2007-11-22
Onset:2008-01-03
Submitted:2008-08-18
Entered:2008-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Enteritis, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533335A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; Hep B (manufacturer unspecified, intramuscular) given on 20 September 2007, 22 November 2007 and 22 March 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 January 2007, pneumococcal vaccine (manufacturer unspecified, intramuscular) given on 22 November 2007 and 22 January 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 20 September 2007. On 22 November 2007, the subject received 1st dose of ROTARIX (1 ml, oral). Lot number not provided. On 3 January 2008, 42 days after vaccination with ROTARIX, the subject was taken to ER, with colicky abdominal pain and 2 evacuations without mucus or blood with initial diagnosis of acute enteritis. After evaluation, intestinal intussusception was diagnosed. The surgery was done on 3 January 2008 and showed ileo-colic intussusception resolved by taxis without resection and complication. The subject had good response and favorable evolution. The subject was hospitalized and the physician considered the events were clinically significant (or requiring intervention). The physician did not have any data about diagnostic procedure. No abdominal X-ray or ultrasound was performed. On 6 January 2008, the events were resolved by surgery and the patient was discharged. After the next vaccination with ROTARIX the events did not recur. The physician considered the events were possibly related to vaccination with ROTARIX.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=322489&WAYBACKHISTORY=ON


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