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This is VAERS ID 384493

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 384493
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 5/13/2013

VAERS ID: 384493 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 9/14/2017

VAERS ID: 384493 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 2/14/2018

VAERS ID: 384493 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 6/14/2018

VAERS ID: 384493 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 8/14/2018

VAERS ID: 384493 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 9/14/2018

VAERS ID: 384493 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.


Changed on 10/14/2018

VAERS ID: 384493 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2007-04-16
Onset:2007-04-21
Submitted:2010-04-07
Entered:2010-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting, No reaction on previous exposure to drug, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound scan, Apr2007, intussusception
CDC 'Split Type': B0645476A

Write-up: This case was reported by the regulatory authority (reference NY20070053) and described the occurrence of intussusception of intestine in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical conditions and concurrent medications were unspecified. Previous vaccination included a first dose of ROTARIX given on 13 March 2007, well tolerated. On 16 April 2007, the subject received a 2nd dose of ROTARIX (batch unknown, oral). On 21 April 2007, five days after vaccination with ROTARIX, the subject was hospitalized for vomiting, bloody and mucous stools without abdominal pain. As vomiting were persisting, an abdominal ultrasound scan was performed and revealed acute intussusception of intestine. Clinical course was favorable after surgery. On 23 April 2007, after three days of hospitalisation, the subject was discharged from hospital. At the time of reporting, intussusception of intestine was improved and other events were resolved. According to the method of assessment, the relationship between vaccination with ROTARIX and the reported events was dubious.

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