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This is VAERS ID 483937

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 483937
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 5/13/2013

VAERS ID: 483937 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 2/14/2017

VAERS ID: 483937 Before After
VAERS Form:
Age:0.3 0.34
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 9/14/2017

VAERS ID: 483937 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 2/14/2018

VAERS ID: 483937 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 6/14/2018

VAERS ID: 483937 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 8/14/2018

VAERS ID: 483937 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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.


Changed on 9/14/2018

VAERS ID: 483937 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Foreign
Vaccinated:2012-05-28
Onset:0000-00-00
Submitted:2013-02-08
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA44AA / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Death, Enterocolitis, Intussusception, Peritonitis, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=483937&WAYBACKHISTORY=ON


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