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This is VAERS ID 336182

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 336182
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 5/13/2013

VAERS ID: 336182 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 9/14/2017

VAERS ID: 336182 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 2/14/2018

VAERS ID: 336182 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 6/14/2018

VAERS ID: 336182 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 8/14/2018

VAERS ID: 336182 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 9/14/2018

VAERS ID: 336182 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.


Changed on 10/14/2018

VAERS ID: 336182 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2008-06-03
Onset:2008-06-11
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: C-reactive protein normal, Echography abnormal, Intussusception, Surgery, White blood cell count increased, X-ray abnormal, Neutrophil percentage increased, 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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, 11Jun2008, see text; C-reactive protein, 11Jun2008, 0.4; Echography, 11Jun2008, see text; Neutrophil count, 11Jun2008, 87%; White blood cell count, 11Jun2008, 17600/mm3
CDC 'Split Type': B0544840A

Write-up: This case was reported by a physician (via a sales representative) and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 3 June 2008, the subject received unspecified dose of ROTARIX (unknown) lot number not provided. On 11 June 2008,8 days after vaccination with ROTARIX, the subject was hospitalized due to severe intussusception. At the time of reporting the outcome of the event was unspecified. Follow up information received on 24 December 2008 from the physician: Previous vaccination included ROTARIX (GlaxoSmithKline, oral) given in May 2008. On 11 June 2008, 8 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception which was reduced by surgery on 11 June 2008. The subject was hospitalized and the physician considered the event was clinically significant (or requiring intervention). Laboratory tests were performed on 11 June 2008 and showed the following results: Abdominal x-ray: fluid levels and dilated bowel loops; Abdominal ultrasound: visible intussusception or soft tissue mass; White blood cells: 17 600 /mm3; Neutrophiles: 87%; CRP: 0.4. At the time of reporting the event was resolved. The physician considered the event was probably related to vaccination with ROTARIX. No further information expected; the case has been closed.

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