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From the 12/31/2003 release of VAERS data (an older release, current is 6/11/2021):

This is VAERS ID 133481



Case Details

VAERS ID: 133481 (history)  
Form: Version .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: 2000-01-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7172DA / 1 L / IM
HBHEPB: COMVAX / MSD 0611J / 1 - / IM
IPV: POLIOVAX / CONNAUGHT LTD P0552 / 1 A / IM
MMR: MMR II / MSD 0130J / 0 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: FEBRILE SEIZURE, HYPOXIA, OTITIS MED
SMQs:

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:
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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=133481


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