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From the 1/7/2021 release of VAERS data:

This is VAERS ID 284854

Case Details

VAERS ID: 284854 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Unknown  
   Days after vaccination:85
Submitted: 2007-07-16
   Days after onset:54
Entered: 2007-07-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown records received 10/5/07-CT showed intussusception. Small amount of air in proximal small bowel. Intussusception started in splenic flexure.
CDC Split Type: WAES0707USA01300

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO "the last dose". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from intussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested. 10/5/07-records received from facility for DOS 5/23-5/25/07-Seen in ER. DX:Intussusception-reducted by fluoroscopically guided air enema. HX of abdominal pain and bloody stools this morning,

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