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This is VAERS ID 548128

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2014

VAERS ID: 548128
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2014-06-04
Onset:2014-10-01
Submitted:2014-10-15
Entered:2014-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS L24JG / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J007096 / - UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75064 / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB393A / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Diet refusal, Haematochezia, Intussusception, Irritability, Lethargy, Malaise, Teething, Vomiting, Urine output decreased, Gastrointestinal sounds abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2014GSK005690

Write-up: This case was reported by a other health professional and described the occurrence of intussusception in a 8-month-old male patient who received ROTARIX (batch number A41CB393A, expiry date 5th October 2016). Concomitant products included ROTARIX, PEDIARIX, PREVENAR and HIB. On 4th June 2014 11:30, the patient received the 2nd dose of ROTARIX (oral). On 1st October 2014, 119 days after receiving ROTARIX, the patient experienced intussusception (serious criteria hospitalization, GSK medically significant, life threatening and clinically significant/intervention required), bloody stool (serious criteria GSK medically significant) and absent bowel sounds. On an unknown date, the outcome of the intussusception, bloody stool and absent bowel sounds were not recovered/not resolved. It was unknown if the reporter considered the intussusception, bloody stool and absent bowel sounds to be related to ROTARIX. Additional information was provided. The patient had no known allergy, no relevant medical history and no reaction to previous vaccinations. The patient had no current medication. At the time of reporting, the patient was hospitalized, the events were worsened and the patient was possibly having surgery.


Changed on 3/14/2015

VAERS ID: 548128 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2014-06-04
Onset:2014-10-01
Submitted:2014-10-15
Entered:2014-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS L24JG / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J007096 / - UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75064 / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB393A / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Diet refusal, Haematochezia, Intussusception, Irritability, Lethargy, Malaise, Teething, Vomiting, Urine output decreased, Gastrointestinal sounds abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2014GSK005690

Write-up: This case was reported by a other health professional and described the occurrence of intussusception in a 8-month-old male patient who received ROTARIX (batch number A41CB393A, expiry date 5th October 2016). Concomitant products included ROTARIX, PEDIARIX, PREVENAR and HIB. On 4th June 2014 11:30, the patient received the 2nd dose of ROTARIX (oral). On 1st October 2014, 119 days after receiving ROTARIX, the patient experienced intussusception (serious criteria hospitalization, GSK medically significant, life threatening and clinically significant/intervention required), bloody stool (serious criteria GSK medically significant) and absent bowel sounds. On an unknown date, the outcome of the intussusception, bloody stool and absent bowel sounds were not recovered/not resolved. It was unknown if the reporter considered the intussusception, bloody stool and absent bowel sounds to be related to ROTARIX. Additional information was provided. The patient had no known allergy, no relevant medical history and no reaction to previous vaccinations. The patient had no current medication. At the time of reporting, the patient was hospitalized, the events were worsened and the patient was possibly having surgery.


Changed on 9/14/2017

VAERS ID: 548128 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:California
Vaccinated:2014-06-04
Onset:2014-10-01
Submitted:2014-10-15
Entered:2014-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS L24JG / 1 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J007096 / - UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75064 / - UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB393A / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Gastrointestinal sounds abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2014GSK005690

Write-up: This case was reported by a other health professional and described the occurrence of intussusception in a 8-month-old male patient who received ROTARIX (batch number A41CB393A, expiry date 5th October 2016). Concomitant products included ROTARIX, PEDIARIX, PREVENAR and HIB. On 4th June 2014 11:30, the patient received the 2nd dose of ROTARIX (oral). On 1st October 2014, 119 days after receiving ROTARIX, the patient experienced intussusception (serious criteria hospitalization, GSK medically significant, life threatening and clinically significant/intervention required), bloody stool (serious criteria GSK medically significant) and absent bowel sounds. On an unknown date, the outcome of the intussusception, bloody stool and absent bowel sounds were not recovered/not resolved. It was unknown if the reporter considered the intussusception, bloody stool and absent bowel sounds to be related to ROTARIX. Additional information was provided. The patient had no known allergy, no relevant medical history and no reaction to previous vaccinations. The patient had no current medication. At the time of reporting, the patient was hospitalized, the events were worsened and the patient was possibly having surgery.


Changed on 2/14/2018

VAERS ID: 548128 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:California
Vaccinated:2014-06-04
Onset:2014-10-01
Submitted:2014-10-15
Entered:2014-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS L24JG / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J007096 / UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75064 / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB393A / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Gastrointestinal sounds abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2014GSK005690

Write-up: This case was reported by a other health professional and described the occurrence of intussusception in a 8-month-old male patient who received ROTARIX (batch number A41CB393A, expiry date 5th October 2016). Concomitant products included ROTARIX, PEDIARIX, PREVENAR and HIB. On 4th June 2014 11:30, the patient received the 2nd dose of ROTARIX (oral). On 1st October 2014, 119 days after receiving ROTARIX, the patient experienced intussusception (serious criteria hospitalization, GSK medically significant, life threatening and clinically significant/intervention required), bloody stool (serious criteria GSK medically significant) and absent bowel sounds. On an unknown date, the outcome of the intussusception, bloody stool and absent bowel sounds were not recovered/not resolved. It was unknown if the reporter considered the intussusception, bloody stool and absent bowel sounds to be related to ROTARIX. Additional information was provided. The patient had no known allergy, no relevant medical history and no reaction to previous vaccinations. The patient had no current medication. At the time of reporting, the patient was hospitalized, the events were worsened and the patient was possibly having surgery.


Changed on 6/14/2018

VAERS ID: 548128 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:California
Vaccinated:2014-06-04
Onset:2014-10-01
Submitted:2014-10-15
Entered:2014-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS L24JG / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J007096 / UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75064 / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB393A / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Gastrointestinal sounds abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2014GSK005690

Write-up: This case was reported by a other health professional and described the occurrence of intussusception in a 8-month-old male patient who received ROTARIX (batch number A41CB393A, expiry date 5th October 2016). Concomitant products included ROTARIX, PEDIARIX, PREVENAR and HIB. On 4th June 2014 11:30, the patient received the 2nd dose of ROTARIX (oral). On 1st October 2014, 119 days after receiving ROTARIX, the patient experienced intussusception (serious criteria hospitalization, GSK medically significant, life threatening and clinically significant/intervention required), bloody stool (serious criteria GSK medically significant) and absent bowel sounds. On an unknown date, the outcome of the intussusception, bloody stool and absent bowel sounds were not recovered/not resolved. It was unknown if the reporter considered the intussusception, bloody stool and absent bowel sounds to be related to ROTARIX. Additional information was provided. The patient had no known allergy, no relevant medical history and no reaction to previous vaccinations. The patient had no current medication. At the time of reporting, the patient was hospitalized, the events were worsened and the patient was possibly having surgery.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=548128&WAYBACKHISTORY=ON


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