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This is VAERS ID 385407

Case Details

VAERS ID: 385407 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Unknown  
Location: Foreign  
Vaccinated:2009-10-01
Onset:2009-10-05
   Days after vaccination:4
Submitted: 2010-04-19
   Days after onset:196
Entered: 2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Death, Intussusception, Similar reaction on previous exposure to drug, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: INVAGINATION OF INTESTINE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0647700B

Write-up: This case was reported by a physician and described the occurrence of invagination of intestine in a 4-month-old subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). Previous vaccination included 1st dose of ROTARIX (GlaxoSmithKline; oral) given on 29 July 2009. After vaccination with 1st dose of ROTARIX, the subject experienced first episode of intestinal invagination (See case B0647700A). On 1 October 2009, the subject received 2nd dose of ROTARIX (oral). On 5 October 2009, 4 days after vaccination with 2nd dose of ROTARIX, the subject experienced a second episode of intestinal invagination. The subject was hospitalised. Surgery was performed and the subject died on the same day at 9:45 PM. The subject died from intestinal invagination caused by vaccination. It was unknown whether an autopsy was performed. The physician considered the event was almost certainly related to vaccination with ROTARIX.


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