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This is VAERS ID 440681

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2011

VAERS ID: 440681
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2011-08-23
Onset:2011-10-11
Submitted:2011-10-28
Entered:2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Diarrhoea, Intussusception, Retching, Vomiting

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


Changed on 1/15/2012

VAERS ID: 440681 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2011-08-23
Onset:2011-10-11
Submitted:2011-10-28
Entered:2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Diarrhoea, Intussusception, Retching, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No Yes, days: (blank) 3     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.


Changed on 5/13/2013

VAERS ID: 440681 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2011-08-23
Onset:2011-10-11
Submitted:2011-10-28
Entered:2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Diarrhoea, Intussusception, Retching, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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.


Changed on 2/14/2017

VAERS ID: 440681 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:Tennessee
Vaccinated:2011-08-23
Onset:2011-10-11
Submitted:2011-10-28
Entered:2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Diarrhoea, Intussusception, Retching, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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.


Changed on 9/14/2017

VAERS ID: 440681 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:Tennessee
Vaccinated:2011-08-23
Onset:2011-10-11
Submitted:2011-10-28
Entered:2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB106A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Diarrhoea, Intussusception, Retching, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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.


Changed on 2/14/2018

VAERS ID: 440681 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:Tennessee
Vaccinated:2011-08-23
Onset:2011-10-11
Submitted:2011-10-28
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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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