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From the 11/26/2021 release of VAERS data:

This is VAERS ID 27114

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Case Details

VAERS ID: 27114 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Wisconsin  
Vaccinated:1990-10-24
Onset:1990-10-24
   Days after vaccination:0
Submitted: 1990-10-31
   Days after onset:7
Entered: 1990-12-18
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC Split Type: WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


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