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This is VAERS ID 392108

Case Details

VAERS ID: 392108 (history)  
Form: Version 1.0  
Age: 0.19  
Gender: Male  
Location: Foreign  
Vaccinated:2006-09-26
Onset:2006-10-03
   Days after vaccination:7
Submitted: 2010-07-06
   Days after onset:1372
Entered: 2010-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Death, Haematochezia, Intussusception, Rectal haemorrhage, Sepsis, Surgery, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-10-06
   Days after onset: 3
Permanent Disability? No
Recovered? No
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: X-ray, 04Oct2006, IS
CDC Split Type: B0662987A

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 male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 26 September 2006, the subject received 1st dose of ROTARIX (oral, lot number not provided). On 3 October 2006, 7 days after vaccination with ROTARIX, the subject experienced vomiting, abdominal pain, rectal bleeding, bloody stools and abdominal distension which leaded to medical care. On 3 October 2006, the subject was hospitalised. On 4 October 2006, X-ray suggested intussusception leading to surgery without resection. Sepsis leaded to death on 06 October 2006. Cause of death was not reported. It was unknown whether an autopsy was performed.


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