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This is VAERS ID 483986

Case Details

VAERS ID: 483986 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Female  
Location: Foreign  
Vaccinated:2012-02-23
Onset:2012-03-01
   Days after vaccination:7
Submitted: 2013-02-11
   Days after onset:347
Entered: 2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA350BA / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

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:
Allergies:
Diagnostic Lab Data: Abdominal X-ray, Handles distenti
CDC Split Type: B0865673A

Write-up: This case was reported by a health professional and described the occurrence of intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 23 February 2012, the subject received 1st dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception, cardiorespiratory arrest, hypovolemic shock and multiple organ dysfunction. The subject was hospitalised and the regulatory authority reported that the events were clinically significant (or requiring intervention). An abdominal X-ray confirmed intussusception and showed handles distention. The subject died from cardiorespiratory arrest, hypovolemic shock, intussusception and multiple organ dysfunction. 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 was expected. Case was closed.


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