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

This is VAERS ID 133476



Case Details

VAERS ID: 133476 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Alabama  
Vaccinated:2000-01-19
Onset:2000-01-19
   Days after vaccination:0
Submitted: 2000-01-24
   Days after onset:5
Entered: 2000-01-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467012 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 570403A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 2 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: CSF test, Convulsion, Electroencephalogram abnormal, Herpes simplex serology negative, Laboratory test normal, Musculoskeletal stiffness, Nuclear magnetic resonance imaging normal, Palpitations, Postictal state, Skin discolouration, Somnolence, Staring, Tonic clonic movements, Unresponsive to stimuli, Viral test negative
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG - abnormal, MRI - neg, Viral antigens - neg, CSF results - unk, Septic work up - neg, Herpes test-pending
CDC Split Type:

Write-up: Pt became gray and unresponsive 10 min after starting nap.911 called, pt was staring straight ahead, tonic, stiff. Ativan was administered with good response. HR 150, B/P 80, palpitations, postictal sleepiness, 8-10 seizures.Hospitalized. Follow-up: 2/15/00 consent form returned by parent - Mailed with letter to hospital.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133476


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