From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 33136

Case Details

VAERS ID:	33136 (history)
Form:	Version .0
Age:	0.2
Sex:	Male
Location:	Oklahoma

Vaccinated:	1969-12-18
Onset:	1969-12-18
Days after vaccination:	0
Submitted:	0000-00-00
Entered:	1991-08-06

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTP: UNK. DTP / UNCLASSIFIED	- / -	- / -

Administered by: Private Purchased by: Unknown
Symptoms: CONVULS, CONVULS GRAND MAL, FEVER
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC Split Type: seizure disorder

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=33136