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

This is VAERS ID 133814



Case Details

VAERS ID: 133814 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:2000-01-04
Onset:2000-01-05
   Days after vaccination:1
Submitted: 2000-01-05
   Days after onset:0
Entered: 2000-02-08
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, Otitis media
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133814


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