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This is VAERS ID 336621

Case Details

VAERS ID: 336621 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Foreign  
Vaccinated:2007-12-13
Onset:2008-01-09
   Days after vaccination:27
Submitted: 2009-01-06
   Days after onset:363
Entered: 2009-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Blood potassium normal, Blood sodium normal, Gastrointestinal sounds abnormal, Haematochezia, Haemoglobin normal, Intussusception, Lymphocyte count normal, Mucous stools, Neutrophil count normal, Surgery, Vomiting, White blood cell count decreased
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Hemoglobin, 09Jan2008, 12.5mg/dl; Lymphocytes, 09Jan2008, 2500/mm3; Neutrophils, 09Jan2008, 3120/mm3; Potassium, 09Jan2008, 5.2mEq/dl; Sodium, 09Jan2008, 144mEq/dl; White blood cell count, 09Jan2008, 5800/mm3
CDC Split Type: B0552335A

Write-up: This case was reported by a physician in the frame of a PASS study and described the occurrence of ileocolic intussusception in a 3-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject was under no other medication and had no relevant medical history nor allergy. The subject was healthy. On 13 December 2007, the subject received 1st dose of ROTARIX (oral), lot number not provided. On 9 January 2008, 27 days after vaccination with ROTARIX, the subject experienced vomiting and bloody stools. She was brought to the emergency ward where the physical examination revealed bowel sounds decreased and current jelly stools. Intussusception was suspected. On 10 January 2008, surgery was performed and ileocolic intussusception was found and reduced by taxis without complication. The subject was hospitalised for 5 days and the physician considered the events were clinically significant (or requiring intervention). On 13 January 2008, the events were resolved and the subject was discharged from hospital in good clinical condition. The physician considered the events were possibly related to vaccination with ROTARIX.


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