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From the 12/8/2009 release of VAERS data (an older release, current is 4/30/2021):

This is VAERS ID 25664



Case Details

VAERS ID: 25664 (history)  
Form: Version .0  
Age: 0.5  
Sex: Female  
Location: Delaware  
Vaccinated:1990-07-18
Onset:1990-07-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 2 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Hypokinesia, Hypotonia, Muscle twitching, Pallor, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Premie 32 wk gestation
Allergies:
Diagnostic Lab Data: Normal EEG
CDC Split Type:

Write-up: Pt received 3rd DTP at noon 18-JUL-90 approx 24 hrs later temp 103, episode of poor color, staring expression, hypotonia. Twitching & color change cleared in seconds, hypotonia & expressionless face for minutes. More details see WORM.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=25664


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