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From the 2/26/2021 release of VAERS data:

This is VAERS ID 293837

Case Details

VAERS ID: 293837 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
   Days after vaccination:64
Submitted: 2007-10-19
   Days after onset:83
Entered: 2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Similar reaction on previous exposure to drug
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for Intussusception in the RLQ. Barium Enema with reduction of IS. CBC with WBC 18.1. Labs and Diagnostics 9/8/07: CBC WNL. Abd X-ray (+) filling defect near hepatic flexure, probable Intussusception. Barium enema with reflux of contrast into small bowel and reduction of what is believed to be an ileocolonic type intussusception./
CDC Split Type:

Write-up: After first dose of Rotateq developed intussusception approx. 5 weeks later. After second dose of Rotateq developed intussusception one week later. Both episdoses treated at Hospital. 10/29/2007 MR received for hospital DOS 7/28-29/2007 fo Dx: Intussusception. Infant initially presented with inconsolable crying and blood in stool. Vomiting developed which was green initially then orange. Rectal exam at another facility (+) for rectal bleeding and pt transfered to current facility. In ER had Currant Jelly stool, Guiac (+). Decreased po intake. Infant had a successful reduction of Intussusception via Barium enema. 10/31/2007 Vax record received and submitted for scanning. Lot number same as VAERS report. 01/25/2008 MR received for ER visit 9/08/2007 with DX: Intussusception-reduced spontaneously. Child presented to ER with blood in stool which "looked like jelly", vomiting and abdominal pain. Rust colored sputum noted in tracea on PE.

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