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This is VAERS ID 322638

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 322638
VAERS Form:
Age:0.1
Gender:Female
Location:Foreign
Vaccinated:2007-12-12
Onset:2008-04-03
Submitted:2008-08-19
Entered:2008-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Surgery, Vomiting, Gastric disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533447A

Write-up: This case was reported by a physician and described the occurrence of ileo-ceco-colic intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTPa-IPV-HIB (manufacturer unspecified, intramuscular) given on 12 December 2007, 15 February 2008 and 15 April 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 12 December 2007 and 15 February 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 25 October 2007. On 12 December 2007, the subject received 1st dose of ROTARIX (oral). Lot number not provided. On 3 April 2008, 113 days after vaccination with ROTARIX, the subject was taken to ER with gastric intolerance with 5 episodes of vomiting and 2 bloody stools like black currant jelly. The diagnosis was done clinically. Surgery was performed on 3 April 2008 and showed ileo-ceco-colic intussusception resolved by taxis with prophylactic appendectomy without resection and complication. The patient had good response and was discharged on 6 April 2008. No abdominal x-ray, ultrasound or scan was performed. The physician considered the events were clinically significant (or requiring intervention). On 6 April 2008, the events were resolved. The physician considered the events were unrelated to vaccination with ROTARIX.


Changed on 5/13/2013

VAERS ID: 322638 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Foreign
Vaccinated:2007-12-12
Onset:2008-04-03
Submitted:2008-08-19
Entered:2008-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Surgery, Vomiting, Gastric disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533447A

Write-up: This case was reported by a physician and described the occurrence of ileo-ceco-colic intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTPa-IPV-HIB (manufacturer unspecified, intramuscular) given on 12 December 2007, 15 February 2008 and 15 April 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 12 December 2007 and 15 February 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 25 October 2007. On 12 December 2007, the subject received 1st dose of ROTARIX (oral). Lot number not provided. On 3 April 2008, 113 days after vaccination with ROTARIX, the subject was taken to ER with gastric intolerance with 5 episodes of vomiting and 2 bloody stools like black currant jelly. The diagnosis was done clinically. Surgery was performed on 3 April 2008 and showed ileo-ceco-colic intussusception resolved by taxis with prophylactic appendectomy without resection and complication. The patient had good response and was discharged on 6 April 2008. No abdominal x-ray, ultrasound or scan was performed. The physician considered the events were clinically significant (or requiring intervention). On 6 April 2008, the events were resolved. The physician considered the events were unrelated to vaccination with ROTARIX.


Changed on 9/14/2017

VAERS ID: 322638 Before After
VAERS Form:(blank) 1
Age:0.1
Gender:Female
Location:Foreign
Vaccinated:2007-12-12
Onset:2008-04-03
Submitted:2008-08-19
Entered:2008-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Surgery, Vomiting, Gastric disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533447A

Write-up: This case was reported by a physician and described the occurrence of ileo-ceco-colic intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTPa-IPV-HIB (manufacturer unspecified, intramuscular) given on 12 December 2007, 15 February 2008 and 15 April 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 12 December 2007 and 15 February 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 25 October 2007. On 12 December 2007, the subject received 1st dose of ROTARIX (oral). Lot number not provided. On 3 April 2008, 113 days after vaccination with ROTARIX, the subject was taken to ER with gastric intolerance with 5 episodes of vomiting and 2 bloody stools like black currant jelly. The diagnosis was done clinically. Surgery was performed on 3 April 2008 and showed ileo-ceco-colic intussusception resolved by taxis with prophylactic appendectomy without resection and complication. The patient had good response and was discharged on 6 April 2008. No abdominal x-ray, ultrasound or scan was performed. The physician considered the events were clinically significant (or requiring intervention). On 6 April 2008, the events were resolved. The physician considered the events were unrelated to vaccination with ROTARIX.


Changed on 2/14/2018

VAERS ID: 322638 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Foreign
Vaccinated:2007-12-12
Onset:2008-04-03
Submitted:2008-08-19
Entered:2008-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Surgery, Vomiting, Gastric disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0533447A

Write-up: This case was reported by a physician and described the occurrence of ileo-ceco-colic intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical history. Previous and/or concurrent vaccination included DTPa-IPV-HIB (manufacturer unspecified, intramuscular) given on 12 December 2007, 15 February 2008 and 15 April 2008; pneumococcal vaccine, unspecified (manufacturer unspecified, intramuscular) given on 12 December 2007 and 15 February 2008; tuberculosis vaccine (manufacturer unspecified, intradermal) given on 25 October 2007. On 12 December 2007, the subject received 1st dose of ROTARIX (oral). Lot number not provided. On 3 April 2008, 113 days after vaccination with ROTARIX, the subject was taken to ER with gastric intolerance with 5 episodes of vomiting and 2 bloody stools like black currant jelly. The diagnosis was done clinically. Surgery was performed on 3 April 2008 and showed ileo-ceco-colic intussusception resolved by taxis with prophylactic appendectomy without resection and complication. The patient had good response and was discharged on 6 April 2008. No abdominal x-ray, ultrasound or scan was performed. The physician considered the events were clinically significant (or requiring intervention). On 6 April 2008, the events were resolved. The physician considered the events were unrelated to vaccination with ROTARIX.


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