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This is VAERS ID 543420

Case Details

VAERS ID: 543420 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:2014-01-14
Onset:2014-01-19
   Days after vaccination:5
Submitted: 2014-08-12
   Days after onset:204
Entered: 2014-09-11
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS FF723 / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH872AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB374A / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: At the time of reporting, there were no concomitant medications or relevant medical history. The subject had no known drug allergies. There were no reported adverse reactions to previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A1057509A

Write-up: This case was reported by a physician and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). Concurrent vaccination included DTaP-IPV/HepB; GlaxoSmithKline; unknown; unknown given on 14 January 2014; Hib (non-gsk); non-GSK manufacturer; unknown; unknown given on 14 January 2014; pneumococcal vaccines (non-gsk); non-GSK manufacturer; unknown; unknown given on 14 January 2014. On 14 January 2014 at 09:36 the subject received 1st dose of ROTARIX (1 ml, oral). On 19 January 2014, 5 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised and the physician considered the event was life threatening and clinically significant (or requiring intervention). At the time of reporting the event was resolved. The vaccination course with ROTARIX was discontinued. The physician considered the event was probably related to vaccination with ROTARIX.


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