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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 25013

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Case Details

VAERS ID: 25013 (history)  
Form: Version .0  
Age: 0.4  
Sex: Unknown  
Location: North Dakota  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE - / - - / -
OPV: ORIMUNE / LEDERLE - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: ERYTHEMA MULT, RASH
SMQs:

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received DTP/OPV vaccine developed rash in groin area, became wide spread, DX rash, erythema multiforme (E.R. report indicates due to OPV vaccine) At 6 mon. child received DTP w/ no problems.


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