National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 386984

History of Changes from the VAERS Wayback Machine

First Appeared on 5/11/2010

VAERS ID: 386984
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 5/13/2013

VAERS ID: 386984 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 9/14/2017

VAERS ID: 386984 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 2/14/2018

VAERS ID: 386984 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 6/14/2018

VAERS ID: 386984 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 8/14/2018

VAERS ID: 386984 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 9/14/2018

VAERS ID: 386984 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.


Changed on 10/14/2018

VAERS ID: 386984 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:2010-01-15
Onset:2010-02-02
Submitted:2010-05-07
Entered:2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Body temperature increased, Intussusception, Pyrexia, Enema administration, Ultrasound scan abnormal

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history
Allergies:
Diagnostic Lab Data: Body temperature, 02Feb2010, increased; Ultrasound scan, Feb2010, intussusception
CDC 'Split Type': B0650695A

Write-up: This case was reported by the regulatory authority (BX20100405) and described the occurrence of intussusception of intestine in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant past medical history. On 15 January 2010, the subject received an unspecified dose of ROTARIX (batch unknown, oral). On 02 February 2010, 18 days after vaccination with ROTARIX, the subject presented with febricula and abdominal pain leading to hospitalisation. Ultrasound scan confirmed diagnosis of acute intussusception of intestine. Intussusception was reduced by enema. On 05 February 2010, febricula and abdominal pain resolved. From 18 to 19 March 2010, the subject was again hospitalized for a new episode of abdominal pain probably unrelated to previous intussusception. A virosis was evoked (incidental events). ROTARIX has not been readministered. According to the method of assessment, the relationship between the reported events and vaccination with ROTARIX was dubious.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=386984&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166