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This is VAERS ID 391798

History of Changes from the VAERS Wayback Machine

First Appeared on 7/31/2010

VAERS ID: 391798
VAERS Form:
Age:0.5
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 5/13/2013

VAERS ID: 391798 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
Entered:2010-06-30
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: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 2/14/2017

VAERS ID: 391798 Before After
VAERS Form:
Age:0.5 0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 9/14/2017

VAERS ID: 391798 Before After
VAERS Form:(blank) 1
Age:0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 2/14/2018

VAERS ID: 391798 Before After
VAERS Form:1
Age:0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
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: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 6/14/2018

VAERS ID: 391798 Before After
VAERS Form:1
Age:0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
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: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 8/14/2018

VAERS ID: 391798 Before After
VAERS Form:1
Age:0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
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: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 9/14/2018

VAERS ID: 391798 Before After
VAERS Form:1
Age:0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
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: Intussusception, Intestinal anastomosis, Colectomy

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': 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.


Changed on 10/14/2018

VAERS ID: 391798 Before After
VAERS Form:1
Age:0.45
Sex:Female
Location:Foreign
Vaccinated:2008-01-30
Onset:2008-02-18
Submitted:2010-06-30
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: Intussusception, Intestinal anastomosis, Colectomy

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': 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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