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This is VAERS ID 483937

Case Details

VAERS ID: 483937 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Foreign  
Submitted: 2013-02-08
Entered: 2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock
SMQs:, Agranulocytosis (broad), Toxic-septic shock conditions (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0865631A

Write-up: This case was reported by other health professional (National Immunization Program) and described the occurrence of intussusception of intestine in a 6-month-old male subject who was vaccinated with live ROTARIX (GlaxoSmithKline). On 28 May 2012, the subject received 2nd dose of ROTARIX (oral). In 2012, at an unspecified time after vaccination with ROTARIX, the subject experienced intussusception of intestine, septic shock, peritonitis and enterocolitis. The subject was hospitalised and the healthcare professional considered the events were clinically significant (or requiring intervention). The subject died from enterocolitis, intussusception of intestine, peritonitis and septic shock. It was unknown whether an autopsy was performed. This report is one of 800 cases received as part of a line-listing, each containing minimal information. No further information is expected.

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