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This is VAERS ID 385407

History of Changes from the VAERS Wayback Machine

First Appeared on 5/11/2010

VAERS ID: 385407
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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: 0     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.


Changed on 8/31/2010

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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: 0 (blank)     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.


Changed on 4/13/2011

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug, Vaccine positive rechallenge

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 5/13/2011

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug, Vaccine positive rechallenge

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 6/11/2011

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug, Vaccine positive rechallenge

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 5/13/2013

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
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: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug, Vaccine positive rechallenge

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 3/14/2015

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug, Vaccine positive rechallenge

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 2/14/2017

VAERS ID: 385407 Before After
VAERS Form:
Age:0.3 0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 9/14/2017

VAERS ID: 385407 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
Entered:2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Intussusception, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 2/14/2018

VAERS ID: 385407 Before After
VAERS Form:1
Age:0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
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, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 6/14/2018

VAERS ID: 385407 Before After
VAERS Form:1
Age:0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
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, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 8/14/2018

VAERS ID: 385407 Before After
VAERS Form:1
Age:0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
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, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 9/14/2018

VAERS ID: 385407 Before After
VAERS Form:1
Age:0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
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, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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.


Changed on 10/14/2018

VAERS ID: 385407 Before After
VAERS Form:1
Age:0.34
Sex:Unknown
Location:Foreign
Vaccinated:2009-10-01
Onset:2009-10-05
Submitted:2010-04-19
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, Surgery, Similar reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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:     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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