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This is VAERS ID 440681

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

Case Details

VAERS ID: 440681 (history)  
Form: Version 1.0  
Age: 0.19  
Gender: Male  
Location: Tennessee  
Vaccinated:2011-08-23
Onset:2011-10-11
   Days after vaccination:49
Submitted: 2011-10-28
   Days after onset:17
Entered: 2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Diarrhoea, Intussusception, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0950728A

Write-up: This case was reported by a healthcare professional via a sales representative and described the occurrence of intussusception in a male subject of unspecified age who was vaccinated with ROTARIX (GlaxoSmithKline). On 23 August 2011 the subject received 1st dose of ROTARIX (oral). On 11 October 2011, 49 days after vaccination with ROTARIX, the subject experienced intussusception, vomiting, diarrhea and dry heaves. This case was assessed as medically serious by GSK. 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=440681


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