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This is VAERS ID 384491

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 384491
VAERS Form:
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 5/13/2013

VAERS ID: 384491 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 9/14/2017

VAERS ID: 384491 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 2/14/2018

VAERS ID: 384491 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 6/14/2018

VAERS ID: 384491 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 8/14/2018

VAERS ID: 384491 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 9/14/2018

VAERS ID: 384491 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.


Changed on 10/14/2018

VAERS ID: 384491 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Foreign
Vaccinated:2006-12-08
Onset:2007-04-14
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA194B / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, Laboratory test abnormal, Vomiting, Enema administration

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: At the time of ROTARIX administration, no other vaccine was administered, no concurrent medication was taken, no vomiting or diarrhea episode occurred.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0645472A

Write-up: This case was reported by the regulatory authority (reference RN0700227) and described the occurrence of intussusception of intestine in a 6.5-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). At the time of ROTARIX administration, no other vaccine was co-administered, no concurrent medication was taken. At the time of events, the subject weighted 8 kg and measured 71 cm. On 08 December 2006, the subject received a 1st dose of ROTARIX (batch A41DA194B, oral). There was no vomiting or diarrhea episode at the time of vaccination. On 14 April 2007, four months after vaccination with ROTARIX, the subject was hospitalized for abdominal pain and vomiting without rectorrhagia due to an acute ileocolic intussusception (unspecified diagnostic test). Intussusception was reduced by air enema under general anaesthesia. Bowel movements passed normally on day two. The regulatory authority reported that the events were life threatening. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported event was dubious.

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