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This is VAERS ID 440249

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 440249 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Female  
Location: New York  
Vaccinated:2011-06-20
Onset:2011-07-30
   Days after vaccination:40
Submitted: 2011-10-26
   Days after onset:88
Entered: 2011-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB158A / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Haematochezia, Intussusception, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0950139A

Write-up: This case was reported by a sales representative and described the occurrence of intussusception in a 4-month-old subject of unspecified gender who was vaccinated with ROTARIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. On an unspecified date, when the subject was 8 weeks of age, the subject received 1st dose of ROTARIX (oral). Less than one year after vaccination with ROTARIX, at 4 months of age, the subject experienced intussusception, vomiting, blood in stools and nausea. The subject was hospitalised. At the time of reporting the outcome of the events was unspecified.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=440249


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