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From the 1/7/2022 release of VAERS data:

This is VAERS ID 194966

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Case Details

VAERS ID: 194966 (history)  
Form: Version 1.0  
Sex: Male  
Location: North Carolina  
Submitted: 2002-12-12
Entered: 2002-12-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Drug toxicity, Mental retardation severity unspecified, Neurodevelopmental disorder
SMQs:, Anticholinergic syndrome (broad), Drug abuse and dependence (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? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ5638006DEC2002

Write-up: A legal complaint was received on 12/03/02 from an attorney alleging that a child received series of Engerix B, Tripedia, Tetramune, Hib-Titer, Tri-Immunol and Flu Shield vaccines from 12/31/92 through 11/12/98 and subsequently experienced "toxic neurological effects of mercury poisoning." The legal complaint also stated that the pt experienced "mental and intellectual incapacity, developmental incapacity, learning disabilities, and affect disorders and impairments." The pt''s symptoms resulted in persistent or significant disability/incapacity. Vaccine info contained in the legal complaint indicated that the child received Engerix B, Tripedia, Tetramune, Hib-Titer, Tri-Immunol, and Flu shield vaccines during the first years of life.

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