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

This is VAERS ID 318547

Case Details

VAERS ID: 318547 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Kansas  
Vaccinated:2008-02-12
Onset:2008-02-29
   Days after vaccination:17
Submitted: 2008-07-08
   Days after onset:129
Entered: 2008-07-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC Split Type: WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


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