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This is VAERS ID 543471

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2014

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

Changed on 2/14/2017

VAERS ID: 543471 Before After
VAERS Form:
Age:0.2 0.17
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

Changed on 9/14/2017

VAERS ID: 543471 Before After
VAERS Form:(blank) 1
Age:0.17
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 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

Changed on 2/14/2018

VAERS ID: 543471 Before After
VAERS Form:1
Age:0.17
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

Changed on 6/14/2018

VAERS ID: 543471 Before After
VAERS Form:1
Age:0.17
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

Changed on 8/14/2018

VAERS ID: 543471 Before After
VAERS Form:1
Age:0.17
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

Changed on 9/14/2018

VAERS ID: 543471 Before After
VAERS Form:1
Age:0.17
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A1061046A

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.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=543471&WAYBACKHISTORY=ON


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