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This is VAERS ID 336192

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 336192
VAERS Form:
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 5/13/2013

VAERS ID: 336192 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
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: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 9/14/2017

VAERS ID: 336192 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 2/14/2018

VAERS ID: 336192 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 6/14/2018

VAERS ID: 336192 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 8/14/2018

VAERS ID: 336192 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 9/14/2018

VAERS ID: 336192 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


Changed on 10/14/2018

VAERS ID: 336192 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Foreign
Vaccinated:2008-08-13
Onset:2008-08-29
Submitted:2008-12-29
Entered:2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

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: UNK
CDC 'Split Type': B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.

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