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This is VAERS ID 336189

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 336189 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Foreign  
Vaccinated:2008-01-01
Onset:2008-11-28
   Days after vaccination:332
Submitted: 2008-12-29
   Days after onset:31
Entered: 2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium enema, Enema administration, Intussusception
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0551651A

Write-up: This case was reported by a physician via a GSK representative and described the occurrence of invagination of intestine in a 13 month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Medical condition was unspecified. First dose of ROTARIX was given in December 2007. In January 2008, the subject received a 2nd dose of ROTARIX (oral, batch not available). On 28 November 2008, 10 months after the second vaccination with ROTARIX, the subject developed invagination of intestine, confirmed by unspecified investigations. The subject was treated with barium salt and event resolved without sequelae. This case was assessed as medically serious by GSK. The physician considered the event was unrelated to vaccination with ROTARIX.


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