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From the 12/31/2003 release of VAERS data (an older release, current is 4/30/2021):

This is VAERS ID 25492



Case Details

VAERS ID: 25492 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: Iowa  
Vaccinated:1990-06-15
Onset:1990-06-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 279947 / - - / IM
OPV: ORIMUNE / LEDERLE 275933 / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: AGITATION, HYPOTONIA, PALLOR
SMQs:

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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: limp, pale, excessive irritability hypotonic


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=25492


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