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

This is VAERS ID 296290

Case Details

VAERS ID:	296290 (history)
Form:	Version 1.0
Age:	0.3
Sex:	Female
Location:	New York

Vaccinated:	2007-10-31
Onset:	2007-11-06
Days after vaccination:	6
Submitted:	2007-11-09
Days after onset:	3
Entered:	2007-11-09

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B194AA / 2	RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0676U / 2	LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B50007A / 2	LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0876U / 2	MO / PO

Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC Split Type:

Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.

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