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This is VAERS ID 332984

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 332984
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-09-29
Onset:2008-10-04
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Crying, Fatigue, Haematochezia, Intussusception, Lethargy, X-ray abnormal, Ultrasound scan abnormal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, see text; Diagnostic ultrasound, see text
CDC 'Split Type': B0542225A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 29 September 2008 the subject received unspecified dose of ROTARIX (oral) lot number not provided. On 4 October 2008, 5 days after vaccination with ROTARIX, the subject experienced intussusception which was resolved by single contrast enema. The physician considered the event was clinically significant (or requiring intervention). Relevant test results included abnormal ultrasound. On 4 October 2008, the event was resolved. The physician considered the event was possibly related to vaccination with ROTARIX. Follow up received on 20 November 2008: The physician that reported intussusception was not the physician who vaccinated the child. The reporter refused to give the name of the pediatrician who followed up the baby since birth. Then further details about vaccination could not be obtained. Five days post vaccination the subject developed lethargy, fatigue, loss of appetite, intractable crying and bloody stool. Relevant test included abdominal x-ray which demonstrated invagination of the intestine by air/liquid contrast enema. Abdominal ultrasound showed visible intussusception or soft tissue mass and demonstration of an intra-abdominal mass with specific characteristic features that is proven to be reduced by hydrostatic enema on post-reduction ultrasound.


Changed on 5/13/2013

VAERS ID: 332984 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-09-29
Onset:2008-10-04
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Crying, Fatigue, Haematochezia, Intussusception, Lethargy, X-ray abnormal, Ultrasound scan abnormal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, see text; Diagnostic ultrasound, see text
CDC 'Split Type': B0542225A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 29 September 2008 the subject received unspecified dose of ROTARIX (oral) lot number not provided. On 4 October 2008, 5 days after vaccination with ROTARIX, the subject experienced intussusception which was resolved by single contrast enema. The physician considered the event was clinically significant (or requiring intervention). Relevant test results included abnormal ultrasound. On 4 October 2008, the event was resolved. The physician considered the event was possibly related to vaccination with ROTARIX. Follow up received on 20 November 2008: The physician that reported intussusception was not the physician who vaccinated the child. The reporter refused to give the name of the pediatrician who followed up the baby since birth. Then further details about vaccination could not be obtained. Five days post vaccination the subject developed lethargy, fatigue, loss of appetite, intractable crying and bloody stool. Relevant test included abdominal x-ray which demonstrated invagination of the intestine by air/liquid contrast enema. Abdominal ultrasound showed visible intussusception or soft tissue mass and demonstration of an intra-abdominal mass with specific characteristic features that is proven to be reduced by hydrostatic enema on post-reduction ultrasound.


Changed on 9/14/2017

VAERS ID: 332984 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-09-29
Onset:2008-10-04
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Crying, Fatigue, Haematochezia, Intussusception, Lethargy, X-ray abnormal, Ultrasound scan abnormal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, see text; Diagnostic ultrasound, see text
CDC 'Split Type': B0542225A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 29 September 2008 the subject received unspecified dose of ROTARIX (oral) lot number not provided. On 4 October 2008, 5 days after vaccination with ROTARIX, the subject experienced intussusception which was resolved by single contrast enema. The physician considered the event was clinically significant (or requiring intervention). Relevant test results included abnormal ultrasound. On 4 October 2008, the event was resolved. The physician considered the event was possibly related to vaccination with ROTARIX. Follow up received on 20 November 2008: The physician that reported intussusception was not the physician who vaccinated the child. The reporter refused to give the name of the pediatrician who followed up the baby since birth. Then further details about vaccination could not be obtained. Five days post vaccination the subject developed lethargy, fatigue, loss of appetite, intractable crying and bloody stool. Relevant test included abdominal x-ray which demonstrated invagination of the intestine by air/liquid contrast enema. Abdominal ultrasound showed visible intussusception or soft tissue mass and demonstration of an intra-abdominal mass with specific characteristic features that is proven to be reduced by hydrostatic enema on post-reduction ultrasound.


Changed on 2/14/2018

VAERS ID: 332984 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2008-09-29
Onset:2008-10-04
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Crying, Fatigue, Haematochezia, Intussusception, Lethargy, X-ray abnormal, Ultrasound scan abnormal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, see text; Diagnostic ultrasound, see text
CDC 'Split Type': B0542225A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 29 September 2008 the subject received unspecified dose of ROTARIX (oral) lot number not provided. On 4 October 2008, 5 days after vaccination with ROTARIX, the subject experienced intussusception which was resolved by single contrast enema. The physician considered the event was clinically significant (or requiring intervention). Relevant test results included abnormal ultrasound. On 4 October 2008, the event was resolved. The physician considered the event was possibly related to vaccination with ROTARIX. Follow up received on 20 November 2008: The physician that reported intussusception was not the physician who vaccinated the child. The reporter refused to give the name of the pediatrician who followed up the baby since birth. Then further details about vaccination could not be obtained. Five days post vaccination the subject developed lethargy, fatigue, loss of appetite, intractable crying and bloody stool. Relevant test included abdominal x-ray which demonstrated invagination of the intestine by air/liquid contrast enema. Abdominal ultrasound showed visible intussusception or soft tissue mass and demonstration of an intra-abdominal mass with specific characteristic features that is proven to be reduced by hydrostatic enema on post-reduction ultrasound.


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