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This is VAERS ID 440249

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2011

440249
VAERS Form:
Age:0.2
Gender:Female
Location:New York
Vaccinated:2011-06-20
Onset:2011-07-30
Submitted:2011-10-26
Entered:2011-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB158A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     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.


Changed on 5/13/2013

440249 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:New York
Vaccinated:2011-06-20
Onset:2011-07-30
Submitted:2011-10-26
Entered:2011-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB158A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB158A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     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.


Changed on 2/14/2017

440249 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:New York
Vaccinated:2011-06-20
Onset:2011-07-30
Submitted:2011-10-26
Entered:2011-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB158A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     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.


Changed on 9/14/2017

440249 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:New York
Vaccinated:2011-06-20
Onset:2011-07-30
Submitted:2011-10-26
Entered:2011-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB158A / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     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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