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| History of Changes from the VAERS Wayback Machine |
| VAERS ID: | 543471 |
| VAERS Form: | |
| Age: | 0.2 |
| Gender: | Female |
| Location: | Unknown |
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 1 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 0 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 0 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 0 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 1 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 0 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 0 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 0 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 1 2 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 0 1 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 0 1 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 0 1 | - MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 2 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 1 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 1 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 1 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 2 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 1 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 1 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 1 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 2 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 1 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 1 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 1 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 2 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 1 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 1 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 1 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
| Vaccinated: | 2013-11-12 |
| Onset: | 2014-01-17 |
| Submitted: | 2014-08-12 |
| Entered: | 2014-09-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | J9MB4 / 2 | RL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | J010383 / 1 | UN / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G39292 / 1 | RL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | AH1CB3353 / 1 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: This case was reported by a physician via sales representative and described the occurrence of intussusception in a subject of unspecified age and gender who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date the subject received a dose of ROTARIX (oral). At an unspecified time after vaccination with ROTARIX, the subject experienced intussusception. Per the reporter, the subject required medical attention and that "it has been taken care of". This case was assessed as medically serious by GSK. At the time of reporting the outcome of the event was unknown. The physician inquired on 7 February 2014 or 10 February 2014 if the subject should receive another ROTARIX dose.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=543471&WAYBACKHISTORY=ON
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