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This is VAERS ID 330202

Case Details

VAERS ID: 330202 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Foreign  
Vaccinated:2007-01-19
Onset:2007-01-23
   Days after vaccination:4
Submitted: 2008-10-27
   Days after onset:642
Entered: 2008-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: UNK
CDC Split Type: B0526919A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 19 January 2007 the subject received unspecified dose of ROTARIX (oral). On 23 January 2007, 4 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the physician considered the event was clinically significant (or requiring intervention). At the time of reporting the event was resolved by taxis. The physician considered the event was almost certainly related to vaccination with ROTARIX. After several attempts no further information could be obtained. Therefore on 24 October 2008 this case has been closed.


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