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From the 4/30/2021 release of VAERS data:

This is VAERS ID 25104

Case Details

VAERS ID: 25104 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Nebraska  
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Gaze palsy, Hypotonia, Injury
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

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