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This is VAERS ID 391672

History of Changes from the VAERS Wayback Machine

First Appeared on 7/31/2010

VAERS ID: 391672
VAERS Form:
Age:0.2
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
Entered:2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AROLA022CA / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Crying, Intussusception, 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: 0     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.


Changed on 5/13/2013

VAERS ID: 391672 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
Entered:2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AROLA022CA / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AROLA022CA / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Crying, Intussusception, 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: 0     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.


Changed on 2/14/2017

VAERS ID: 391672 Before After
VAERS Form:
Age:0.2 0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
Entered:2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AROLA022CA / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Crying, Intussusception, 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: 0     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.


Changed on 9/14/2017

VAERS ID: 391672 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
Entered:2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AROLA022CA / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Crying, Intussusception, 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: 0     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.


Changed on 2/14/2018

VAERS ID: 391672 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
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

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: 0     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.


Changed on 6/14/2018

VAERS ID: 391672 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
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

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: 0     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.


Changed on 8/14/2018

VAERS ID: 391672 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
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

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: 0     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.


Changed on 9/14/2018

VAERS ID: 391672 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
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

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: 0     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.


Changed on 10/14/2018

VAERS ID: 391672 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Foreign
Vaccinated:2008-05-13
Onset:2008-05-16
Submitted:2010-06-29
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

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: 0     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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=391672&WAYBACKHISTORY=ON


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