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This is VAERS ID 324798

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 324798
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 5/13/2013

VAERS ID: 324798 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 6/14/2014

VAERS ID: 324798 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 4/14/2017

VAERS ID: 324798 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 9/14/2017

VAERS ID: 324798 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 2/14/2018

VAERS ID: 324798 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 6/14/2018

VAERS ID: 324798 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 8/14/2018

VAERS ID: 324798 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 9/14/2018

VAERS ID: 324798 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.


Changed on 10/14/2018

VAERS ID: 324798 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-07-15
Onset:2008-07-23
Submitted:2008-09-10
Entered:2008-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Culture stool negative, Intussusception, Surgery, Blood test normal, Incorrect route of drug administration, Vitello-intestinal duct remnant

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test, Jul2008, Normalunit; Stool culture, Jul2008, Negativeunit
CDC 'Split Type': B0535298A

Write-up: This case was reported by a regulatory authority (foreign Regulatory Authority # DHH2301N2008-42013) and described the occurrence of intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKilne). Concurrent medications included Vitamin D. On 15 July 2008, the subject received 1st dose of ROTARIX intramuscular at an unknown injection site instead of orally. The lot number was not provided. On 23 July 2008, 8 days after vaccination with ROTARIX, the subject experienced ileo-ileal intussusception twice, followed by 2 episodes of ileo-colic intussusception within 6 days. The subject was hospitalised. The biology tests performed were normal. Stool culture was negative. No virology test was performed. The subject was treated with surgery. During the surgery, a Meckel''s diverticulum was found. On 30 July 2008, the events were resolved. The vaccination course with ROTARIX was discontinued.

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