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This is VAERS ID 326448

Case Details

VAERS ID: 326448 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Foreign  
Vaccinated:2008-09-13
Onset:2008-09-18
   Days after vaccination:5
Submitted: 2008-09-29
   Days after onset:11
Entered: 2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Mucous stools, Surgery, Ultrasound scan abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, 18Sep2008, ISunit
CDC Split Type: B0538669A

Write-up: This case was reported by a physician and described the occurrence of ileocolic intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 September 2008 the subject received 1st dose of ROTARIX (unknown) lot number not provided. On 18 September 2008, 5 days after vaccination with ROTARIX, the subject presented severe vomiting enough to be hospitalized. The subject cried excessively and passed jelly currant stools. Relevant test included ultrasonography which showed ileocolic intussusception. The following day in the morning the subject underwent a surgery. The subject was hospitalised and the physician considered the events were life threatening and clinically significant (or requiring intervention). At the time of reporting the events were unresolved. The physician considered the events were possibly related to vaccination with ROTARIX.


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