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This is VAERS ID 391672

Case Details

VAERS ID: 391672 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Foreign  
Vaccinated:2008-05-13
Onset:2008-05-16
   Days after vaccination:3
Submitted: 2010-06-29
   Days after onset:774
Entered: 2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AROLA022CA / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Crying, Intussusception, Ultrasound scan abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0662820A

Write-up: This case was reported by a healthcare professional via another manufacturer (Fiocruz) and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 May 2008, the subject received 1st dose of ROTARIX (oral). On 16 May 2008, 3 days after vaccination with ROTARIX, the subject experienced abdominal soreness upon palpation and crying. The subject was hospitalised. An ultrasound confirmed diagnosis of intussusception. At the time of reporting the events were resolved. No further information could be obtained; the case has been closed.


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