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

This is VAERS ID 30903

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Case Details

VAERS ID: 30903 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Michigan  
Vaccinated:1991-05-06
Onset:1991-05-07
   Days after vaccination:1
Submitted: 1991-05-09
   Days after onset:2
Entered: 1991-05-30
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


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