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This is VAERS ID 380532

Case Details

VAERS ID: 380532 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2010-02-16
Entered: 2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Haematochezia, Intussusception, Pneumonia, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0631757A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a baby subject and gender unknown who was vaccinated with ROTARIX (Glaxosmithkline). On an unspecified date, at 3 and 4 months old, the subject received 2nd dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception, pneumonia and bloody stools. The subject was hospitalised due to pneumonia. During first day of hospitalization, the subject developed bloody stools and was operated for intussusception on 3rd day of hospitalization. This case was assessed as medically serious by GSK. At the time of reporting the outcome of the events was unspecified. Further information has been requested.


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