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

This is VAERS ID 28130

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Case Details

VAERS ID: 28130 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Georgia  
Vaccinated:1990-04-10
Onset:1990-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC Split Type: 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


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