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This is VAERS ID 483986

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 483986
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2012-02-23
Onset:2012-03-01
Submitted:2013-02-11
Entered:2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA350BA / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal, Abdominal X-ray

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: 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.


Changed on 5/13/2013

VAERS ID: 483986 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Foreign
Vaccinated:2012-02-23
Onset:2012-03-01
Submitted:2013-02-11
Entered:2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA350BA / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA350BA / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal, Abdominal X-ray

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: 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.


Changed on 2/14/2017

VAERS ID: 483986 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:Foreign
Vaccinated:2012-02-23
Onset:2012-03-01
Submitted:2013-02-11
Entered:2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA350BA / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal, Abdominal X-ray

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: 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.


Changed on 9/14/2017

VAERS ID: 483986 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:Foreign
Vaccinated:2012-02-23
Onset:2012-03-01
Submitted:2013-02-11
Entered:2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS QROLA350BA / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal, Abdominal X-ray

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: 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.


Changed on 2/14/2018

VAERS ID: 483986 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Foreign
Vaccinated:2012-02-23
Onset:2012-03-01
Submitted:2013-02-11
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: Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal, Abdominal X-ray

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: 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.


Changed on 6/14/2018

VAERS ID: 483986 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Foreign
Vaccinated:2012-02-23
Onset:2012-03-01
Submitted:2013-02-11
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: Cardio-respiratory arrest, Death, Hypovolaemic shock, Intussusception, Multi-organ failure, X-ray abnormal, Abdominal X-ray

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: 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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=483986&WAYBACKHISTORY=ON


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