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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1415059



Case Details

VAERS ID: 1415059 (history)  
Form: Version 2.0  
Age: 0.25  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bacterial test negative, Blood glucose normal, Computerised tomogram normal, Electroencephalogram normal, Exposure via breast milk, Lumbar puncture normal, Magnetic resonance imaging normal, Seizure, Viral test negative
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal exposures via breast milk (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Bacterial/viral tests came back negative June 21 Glucose came back negative June 19 Two EEG tests came back normal. June 19&20 MRI/CT scans came back normal. June 19th Spinal test came back normal. June 21
CDC Split Type:

Write-up: I (mother of patient ) received the first dose of the Moderna vaccine on Friday June 18th at approximately 01:30pm. I fed my three month old daughter milk that I pumped from my breasts later that night and put her to bed. When transferring her to her bassinet at approximately 11:30pm, she started a seizure that lasted seven minutes. We were transported to Hospital where she suffered two more seizures in the early morning hours of June 19th. She has been a healthy baby with no health conditions prior to these events.


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