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This is VAERS ID 336192

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

Case Details

VAERS ID: 336192 (history)  
Form: Version .0  
Age: 0.3  
Sex: Female  
Location: Foreign  
Vaccinated:2008-08-13
Onset:2008-08-29
   Days after vaccination:16
Submitted: 2008-12-29
   Days after onset:122
Entered: 2008-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Other       Purchased by: Other
Symptoms: 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? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0551701A

Write-up: This case was reported by a regulatory authority ((clinical) # 118325347) and described the occurrence of ileocolic intussusception in a 4-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 13 August 2008, the subject received unspecified dose of ROTARIX (oral). Lot number not provided. On 29 August 2008, 16 days after vaccination with ROTARIX, the subject experienced ileocolic intussusception. The subject was hospitalised. On 3 September 2008, the event was resolved. The regulatory authority reported that the event was possibly related to vaccination with ROTARIX. No further information was expected as this was the only information the foreign regulatory had, so the case has been closed.


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