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This is VAERS ID 333503

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 333503
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 3/2/2010

VAERS ID: 333503 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 4/7/2010

VAERS ID: 333503 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 8/31/2010

VAERS ID: 333503 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 5/13/2013

VAERS ID: 333503 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 9/14/2017

VAERS ID: 333503 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 2/14/2018

VAERS ID: 333503 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 6/14/2018

VAERS ID: 333503 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 8/14/2018

VAERS ID: 333503 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 9/14/2018

VAERS ID: 333503 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.


Changed on 10/14/2018

VAERS ID: 333503 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-04-22
Onset:2008-06-22
Submitted:2008-12-01
Entered:2008-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Inappropriate schedule of drug administration, Intussusception, Irritability

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548197A

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 6-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant medical or family history. Previous and/or concurrent vaccination included bacillus calmette-guerin vaccine (manufacturer unspecified, intradermal) given on 24 December 2007; DTaP-IPV-HIB (manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; Hep B(manufacturer unspecified, intramuscular) given on 22 February 2008 and 22 April 2008; ROTARIX (GlaxoSmithKline, oral) given on 22 February 2008; pneumococcal vaccine (manufacturer unspecified) given on 22 February 2008 and 22 April 2008. On 22 April 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. on 22 June 2008, 61 days after vaccination with ROTARIX, the subject started with abdominal pain, irritability and hyporexia. The subject was hospitalized and invagination of intestine was diagnosed by clinical data. No x-ray or ultrasound was performed. Intestinal invagination type ileocecocolic without vascular complications was found and resolved by taxis without complications. The physician considered the events were life threatening and clinically significant (or requiring intervention). On 24 June 2008, the events were resolved and the subject was discharged in good conditions. The physician considered the events were possibly related to vaccination with ROTARIX. No further information expected, the case has been closed.

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