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This is VAERS ID 422813

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 422813
VAERS Form:
Age:0.4
Gender:Unknown
Location:Foreign
Vaccinated:2010-07-12
Onset:2010-07-15
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Arrhythmia, Cardiogenic shock, Death, Fatigue, Haematochezia, Hepatic failure, Insomnia, Intussusception, Pyrexia, Septic shock, Vomiting, Gastrointestinal surgery

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-07-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0718451A

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 subject of unspecified gender who was vaccinated with ROTARIX (Fiocruz). Concurrent vaccination included combined diphtheria, tetanus, acellular pertussis and Haemophilus influenzae type b vaccine (manufacturer unspecified, unknown route of administration) and live attenuated oral poliomyelitis vaccine (manufacturer unspecified, oral), given on 12 July 2010. On 12 July 2010, the subject received also 2nd dose of ROTARIX (oral). On 15 July 2010, 3 days after vaccination with ROTARIX, the subject experienced vomiting (first symptoms of intussusception). The subject was hospitalised for vomiting. On 16 July 2010, in the morning, the subject was discharged but was hospitalised again later in the day due to experience of insomnia and bloody stool. In the evening, the subject underwent a surgical reduction of bowels. On 17 July 2010, by dawn, the subject experienced high fever (unknown body temperature), tiredness and arrhythmia. The subject died on 17 July 2010 from anemia (onset unspecified), cardiogenic shock, intussusception (primary cause of death), liver failure and septic shock (secondary cause of death). It was unknown whether an autopsy was performed.


Changed on 5/13/2013

VAERS ID: 422813 Before After
VAERS Form:
Age:0.4
Gender:Unknown
Location:Foreign
Vaccinated:2010-07-12
Onset:2010-07-15
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Arrhythmia, Cardiogenic shock, Death, Fatigue, Haematochezia, Hepatic failure, Insomnia, Intussusception, Pyrexia, Septic shock, Vomiting, Gastrointestinal surgery

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-07-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0718451A

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 subject of unspecified gender who was vaccinated with ROTARIX (Fiocruz). Concurrent vaccination included combined diphtheria, tetanus, acellular pertussis and Haemophilus influenzae type b vaccine (manufacturer unspecified, unknown route of administration) and live attenuated oral poliomyelitis vaccine (manufacturer unspecified, oral), given on 12 July 2010. On 12 July 2010, the subject received also 2nd dose of ROTARIX (oral). On 15 July 2010, 3 days after vaccination with ROTARIX, the subject experienced vomiting (first symptoms of intussusception). The subject was hospitalised for vomiting. On 16 July 2010, in the morning, the subject was discharged but was hospitalised again later in the day due to experience of insomnia and bloody stool. In the evening, the subject underwent a surgical reduction of bowels. On 17 July 2010, by dawn, the subject experienced high fever (unknown body temperature), tiredness and arrhythmia. The subject died on 17 July 2010 from anemia (onset unspecified), cardiogenic shock, intussusception (primary cause of death), liver failure and septic shock (secondary cause of death). It was unknown whether an autopsy was performed.


Changed on 2/14/2017

VAERS ID: 422813 Before After
VAERS Form:
Age:0.4 0.44
Gender:Unknown
Location:Foreign
Vaccinated:2010-07-12
Onset:2010-07-15
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Arrhythmia, Cardiogenic shock, Death, Fatigue, Haematochezia, Hepatic failure, Insomnia, Intussusception, Pyrexia, Septic shock, Vomiting, Gastrointestinal surgery

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-07-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0718451A

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 subject of unspecified gender who was vaccinated with ROTARIX (Fiocruz). Concurrent vaccination included combined diphtheria, tetanus, acellular pertussis and Haemophilus influenzae type b vaccine (manufacturer unspecified, unknown route of administration) and live attenuated oral poliomyelitis vaccine (manufacturer unspecified, oral), given on 12 July 2010. On 12 July 2010, the subject received also 2nd dose of ROTARIX (oral). On 15 July 2010, 3 days after vaccination with ROTARIX, the subject experienced vomiting (first symptoms of intussusception). The subject was hospitalised for vomiting. On 16 July 2010, in the morning, the subject was discharged but was hospitalised again later in the day due to experience of insomnia and bloody stool. In the evening, the subject underwent a surgical reduction of bowels. On 17 July 2010, by dawn, the subject experienced high fever (unknown body temperature), tiredness and arrhythmia. The subject died on 17 July 2010 from anemia (onset unspecified), cardiogenic shock, intussusception (primary cause of death), liver failure and septic shock (secondary cause of death). It was unknown whether an autopsy was performed.


Changed on 9/14/2017

VAERS ID: 422813 Before After
VAERS Form:(blank) 1
Age:0.44
Gender:Unknown
Location:Foreign
Vaccinated:2010-07-12
Onset:2010-07-15
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - MO / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Arrhythmia, Cardiogenic shock, Death, Fatigue, Haematochezia, Hepatic failure, Insomnia, Intussusception, Pyrexia, Septic shock, Vomiting, Gastrointestinal surgery

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-07-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0718451A

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 subject of unspecified gender who was vaccinated with ROTARIX (Fiocruz). Concurrent vaccination included combined diphtheria, tetanus, acellular pertussis and Haemophilus influenzae type b vaccine (manufacturer unspecified, unknown route of administration) and live attenuated oral poliomyelitis vaccine (manufacturer unspecified, oral), given on 12 July 2010. On 12 July 2010, the subject received also 2nd dose of ROTARIX (oral). On 15 July 2010, 3 days after vaccination with ROTARIX, the subject experienced vomiting (first symptoms of intussusception). The subject was hospitalised for vomiting. On 16 July 2010, in the morning, the subject was discharged but was hospitalised again later in the day due to experience of insomnia and bloody stool. In the evening, the subject underwent a surgical reduction of bowels. On 17 July 2010, by dawn, the subject experienced high fever (unknown body temperature), tiredness and arrhythmia. The subject died on 17 July 2010 from anemia (onset unspecified), cardiogenic shock, intussusception (primary cause of death), liver failure and septic shock (secondary cause of death). It was unknown whether an autopsy was performed.


Changed on 2/14/2018

VAERS ID: 422813 Before After
VAERS Form:1
Age:0.44
Gender:Unknown
Location:Foreign
Vaccinated:2010-07-12
Onset:2010-07-15
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Arrhythmia, Cardiogenic shock, Death, Fatigue, Haematochezia, Hepatic failure, Insomnia, Intussusception, Pyrexia, Septic shock, Vomiting, Gastrointestinal surgery

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-07-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0718451A

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 subject of unspecified gender who was vaccinated with ROTARIX (Fiocruz). Concurrent vaccination included combined diphtheria, tetanus, acellular pertussis and Haemophilus influenzae type b vaccine (manufacturer unspecified, unknown route of administration) and live attenuated oral poliomyelitis vaccine (manufacturer unspecified, oral), given on 12 July 2010. On 12 July 2010, the subject received also 2nd dose of ROTARIX (oral). On 15 July 2010, 3 days after vaccination with ROTARIX, the subject experienced vomiting (first symptoms of intussusception). The subject was hospitalised for vomiting. On 16 July 2010, in the morning, the subject was discharged but was hospitalised again later in the day due to experience of insomnia and bloody stool. In the evening, the subject underwent a surgical reduction of bowels. On 17 July 2010, by dawn, the subject experienced high fever (unknown body temperature), tiredness and arrhythmia. The subject died on 17 July 2010 from anemia (onset unspecified), cardiogenic shock, intussusception (primary cause of death), liver failure and septic shock (secondary cause of death). It was unknown whether an autopsy was performed.


Changed on 6/14/2018

VAERS ID: 422813 Before After
VAERS Form:1
Age:0.44
Gender:Unknown
Location:Foreign
Vaccinated:2010-07-12
Onset:2010-07-15
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS XROLA102A1 / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Arrhythmia, Cardiogenic shock, Death, Fatigue, Haematochezia, Hepatic failure, Insomnia, Intussusception, Pyrexia, Septic shock, Vomiting, Gastrointestinal surgery

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-07-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0718451A

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 subject of unspecified gender who was vaccinated with ROTARIX (Fiocruz). Concurrent vaccination included combined diphtheria, tetanus, acellular pertussis and Haemophilus influenzae type b vaccine (manufacturer unspecified, unknown route of administration) and live attenuated oral poliomyelitis vaccine (manufacturer unspecified, oral), given on 12 July 2010. On 12 July 2010, the subject received also 2nd dose of ROTARIX (oral). On 15 July 2010, 3 days after vaccination with ROTARIX, the subject experienced vomiting (first symptoms of intussusception). The subject was hospitalised for vomiting. On 16 July 2010, in the morning, the subject was discharged but was hospitalised again later in the day due to experience of insomnia and bloody stool. In the evening, the subject underwent a surgical reduction of bowels. On 17 July 2010, by dawn, the subject experienced high fever (unknown body temperature), tiredness and arrhythmia. The subject died on 17 July 2010 from anemia (onset unspecified), cardiogenic shock, intussusception (primary cause of death), liver failure and septic shock (secondary cause of death). It was unknown whether an autopsy was performed.

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