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This is VAERS ID 332276

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 332276
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86141 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Enema administration, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type':

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline)"and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intus


Changed on 12/8/2009

VAERS ID: 332276 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86141 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Large intestinal obstruction reduction, Melaena, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': (blank) A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline)"and (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intus intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 3/2/2010

VAERS ID: 332276 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C86141 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Large intestinal obstruction reduction, Melaena, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 4/7/2010

VAERS ID: 332276 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86141 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Large intestinal obstruction reduction, Melaena, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 8/31/2010

VAERS ID: 332276 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C86141 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Large intestinal obstruction reduction, Melaena, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 5/13/2013

VAERS ID: 332276 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86141 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Large intestinal obstruction reduction, Melaena, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 4/14/2017

VAERS ID: 332276 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86141 / 0 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Large intestinal obstruction reduction, Melaena, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 9/14/2017

VAERS ID: 332276 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 0 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86141 / 0 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


Changed on 2/14/2018

VAERS ID: 332276 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-10-03
Onset:2008-10-26
Submitted:2008-11-13
Entered:2008-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF450AB / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86141 / 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA691A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of adverse events following previous vaccinations as this was the subjects first set of vaccinations. PMH: none.
Allergies:
Diagnostic Lab Data: Unk. Labs and diagnostics: Air contrast enema (+) for IS in proximal transverse colon. Abd US (+) for ileocolic IS. Abd X-ray c/w bowel obstruction.
CDC 'Split Type': A0755882A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 9-week-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included ACTHIB (Sanofi), PEDIARIX (GlaxoSmithKline) and PREVENAR (Lederle) all given on 3 October 2008. There were no concurrent medications. On 3 October 2008 at 12:00 the subject received 1st dose of ROTARIX (oral). On 26 October 2008, 23 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject was treated with unknown (Unknown treatment). On 6 November 2008, the event was resolved. The healthcare professional considered the event was probably related to vaccination with ROTARIX. 12/01/2008 MR received for DOS 10/26-30/2008 with D/C DX: Intussusception. Pt presented with 4 day hx of fussiness, intermittent emesis, tarry stool and poor po intake. IS noted on Abd US with attempted air enema reduction which was unsuccessful x 3. Taken to OR for an open reduction of IS, appendectomy and repair of serosal tears. initially NPO with PCA pain mgmt. Transitioned to oral diet and pain meds and d/c on POD#3.


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