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From the 5/7/2021 release of VAERS data (an older release, current is 9/17/2021):

This is VAERS ID 175663



Case Details

VAERS ID: 175663 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Texas  
Vaccinated:1999-06-07
Onset:0000-00-00
Submitted: 2001-07-25
Entered: 2001-09-25
   Days after submission:62
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15534 / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0289J / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Aggression, Autism, Ear disorder, Injection site mass, Irritability, Lethargy, Social avoidant behaviour, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Re-occurring infectious congestion.
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autism - Chat
CDC Split Type:

Write-up: Lethargy, irritability, loss of words, withdrawal, became more aggressive and sensitive to sounds and people, congestion, etc. Knot at the sit of vaccine.


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