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From the 4/23/2021 release of VAERS data:

This is VAERS ID 133481



Case Details

VAERS ID: 133481 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Arizona  
Vaccinated:2000-01-13
Onset:2000-01-14
   Days after vaccination:1
Submitted: 2000-01-18
   Days after onset:4
Entered: 2000-01-27
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media
SMQs:, Asthma/bronchospasm (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Infective pneumonia (broad)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133481


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