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

This is VAERS ID 56175

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Case Details

VAERS ID: 56175 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Texas  
Vaccinated:1993-07-23
Onset:1993-08-10
   Days after vaccination:18
Submitted: 1993-09-14
   Days after onset:35
Entered: 1993-09-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC Split Type:

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


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