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This is VAERS ID 391798

Case Details

VAERS ID: 391798 (history)  
Form: Version 1.0  
Age: 0.45  
Sex: Female  
Location: Foreign  
Vaccinated:2008-01-30
Onset:2008-02-18
   Days after vaccination:19
Submitted: 2010-06-30
   Days after onset:862
Entered: 2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Colectomy, Intestinal anastomosis, Intussusception
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow)

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: B0662908A

Write-up: This case was reported by a healthcare professional via another manufacturer (Fiocruz) and described the occurrence of intussusception in a 5-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 30 January 2008, the subject received 2nd dose of ROTARIX (oral). Lot number not provided. On 18 February 2008, 19 days after vaccination with ROTARIX, the subject experienced right jejuno-ileal intussusception which evolved to a right hemicolectomy and ileocolonic anastomosis. The subject was hospitalised. At the time of reporting the events were resolved. No further information could be obtained; the case has been closed.


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