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This is VAERS ID 331754

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 331754
VAERS Form:
Age:0.6
Gender:Male
Location:Foreign
Vaccinated:2008-07-16
Onset:2008-10-15
Submitted:2008-11-07
Entered:2008-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA502A / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Pharmaceutical product complaint, Ultrasound abdomen abnormal, Abdominal operation, Transmission of an infectious agent via a medicinal product

Life Threatening? Yes
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: Ultrasound abdomen, 16Oct2008, IS
CDC 'Split Type': B0544581A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 10-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous vaccination included ROTARIX (GlaxoSmithKline; oral) given on 18 March 2008. On 16 July 2008, the subject received the 2nd dose of ROTARIX (oral). On 15 October 2008, 91 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. Transmission of an infectious agent via a medicinal product was suspected. The subject presented in ER. On 16 October 2008, abdominal USG was performed and showed intussusception. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 27 October 2008, emergency laparotomy was done to save life. The subject was well after surgery. On 27 October 2008, the events were resolved. The physician considered the events were almost certainly related to vaccination with ROTARIX. This case was associated to a product complaint.


Changed on 5/13/2013

VAERS ID: 331754 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Foreign
Vaccinated:2008-07-16
Onset:2008-10-15
Submitted:2008-11-07
Entered:2008-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA502A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA502A / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Pharmaceutical product complaint, Ultrasound abdomen abnormal, Abdominal operation, Transmission of an infectious agent via a medicinal product

Life Threatening? Yes
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: Ultrasound abdomen, 16Oct2008, IS
CDC 'Split Type': B0544581A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 10-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous vaccination included ROTARIX (GlaxoSmithKline; oral) given on 18 March 2008. On 16 July 2008, the subject received the 2nd dose of ROTARIX (oral). On 15 October 2008, 91 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. Transmission of an infectious agent via a medicinal product was suspected. The subject presented in ER. On 16 October 2008, abdominal USG was performed and showed intussusception. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 27 October 2008, emergency laparotomy was done to save life. The subject was well after surgery. On 27 October 2008, the events were resolved. The physician considered the events were almost certainly related to vaccination with ROTARIX. This case was associated to a product complaint.


Changed on 9/14/2017

VAERS ID: 331754 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:Foreign
Vaccinated:2008-07-16
Onset:2008-10-15
Submitted:2008-11-07
Entered:2008-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA502A / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Pharmaceutical product complaint, Ultrasound abdomen abnormal, Abdominal operation, Transmission of an infectious agent via a medicinal product

Life Threatening? Yes
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: Ultrasound abdomen, 16Oct2008, IS
CDC 'Split Type': B0544581A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 10-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous vaccination included ROTARIX (GlaxoSmithKline; oral) given on 18 March 2008. On 16 July 2008, the subject received the 2nd dose of ROTARIX (oral). On 15 October 2008, 91 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. Transmission of an infectious agent via a medicinal product was suspected. The subject presented in ER. On 16 October 2008, abdominal USG was performed and showed intussusception. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 27 October 2008, emergency laparotomy was done to save life. The subject was well after surgery. On 27 October 2008, the events were resolved. The physician considered the events were almost certainly related to vaccination with ROTARIX. This case was associated to a product complaint.


Changed on 2/14/2018

VAERS ID: 331754 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Foreign
Vaccinated:2008-07-16
Onset:2008-10-15
Submitted:2008-11-07
Entered:2008-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA502A / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Pharmaceutical product complaint, Ultrasound abdomen abnormal, Abdominal operation, Transmission of an infectious agent via a medicinal product

Life Threatening? Yes
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: Ultrasound abdomen, 16Oct2008, IS
CDC 'Split Type': B0544581A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 10-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous vaccination included ROTARIX (GlaxoSmithKline; oral) given on 18 March 2008. On 16 July 2008, the subject received the 2nd dose of ROTARIX (oral). On 15 October 2008, 91 days after vaccination with the 2nd dose of ROTARIX, the subject experienced intussusception. Transmission of an infectious agent via a medicinal product was suspected. The subject presented in ER. On 16 October 2008, abdominal USG was performed and showed intussusception. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 27 October 2008, emergency laparotomy was done to save life. The subject was well after surgery. On 27 October 2008, the events were resolved. The physician considered the events were almost certainly related to vaccination with ROTARIX. This case was associated to a product complaint.


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