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From the 5/7/2021 release of VAERS data:

This is VAERS ID 133420



Case Details

VAERS ID: 133420 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Michigan  
Vaccinated:2000-01-07
Onset:2000-01-07
   Days after vaccination:0
Submitted: 2000-01-10
   Days after onset:3
Entered: 2000-01-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133420


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