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From the 1/14/2022 release of VAERS data:

This is VAERS ID 188628

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Case Details

VAERS ID: 188628 (history)  
Form: Version 1.0  
Age: 2.25  
Sex: Unknown  
Location: Texas  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2002-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autism, Blindness, Convulsion, Deafness, Drug toxicity, Infantile spasms, Mental retardation severity unspecified
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Drug abuse and dependence (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Neonatal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Pt''s hair was tested in which pt had a mercury level of 4.9ppm, which is well above the environmental protection agency 1ppm action level for mercury toxicity. Pt has not been exposed to any heavy metals, lead paint or consumed fish. Hair was tested via a technique called neutron activation analysis to detect various chemicals in hair.
CDC Split Type:

Write-up: My daughter was given the following vaccines on 07/10/01: (1) DTaP, Tripedia, (2) Influenza, (3) hepatitis B. All these vaccines continued "Thimerosal," the very next day after the vaccines were given, my daughter had seizures. I have a detailed contemporaneous medical record that explain in detail this vaccine injury and the medical expert linked the mercury in thimerosal vaccine or causing my daughter permanent injuries. My daughter had a serious vaccine reaction that cannot be overlooked. I was informed to contact you because you monitor the safety of licensed vaccines. The attached medical report clearly reflects that the adverse event occurring after vaccination was actually caused by the vaccination. On 07/11/01, the next day after pt received the vaccines, pt began having seizures and was admitted to hospital from 07/11/01 to 07/14/01 and treated by a neurologist. It was determined that pt was having seizures diagnosed as "infantile spasms," which continued until 9/25/01 and permanently injured pt. Pt is blind in both eyes and deaf in both ears and mentally retarded caused by the infantile spasms. Diagnosis: blind, deaf, mentally retarded, autism. The dangerous mercury levels combined in all vaccines given o pt on 07/10/01 caused pt''s immediate seizures the next day on 07/11/01. Pt was experiencing a normal childhood development until 07/10 & 11/2001, such drastically changed after receiving the vaccines containing Thimerosal. Pt demonstrated autistic like symptoms (infantile spasms) after receiving the injections, such infantile spasms.

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