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From the 12/30/2020 release of VAERS data (an older release, current is 4/30/2021):

This is VAERS ID 25527



Case Details

VAERS ID: 25527 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Florida  
Vaccinated:1990-03-01
Onset:1990-03-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 1990-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0J01114 / 5 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0596E / 4 - / -

Administered by: Private       Purchased by: Private
Symptoms: Encephalitis, Optic neuritis
SMQs:, Noninfectious encephalitis (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No family hx of seizure.Normal growth & development.NK drug allergies,milk allergy
Allergies:
Diagnostic Lab Data: Brain Scan & Biopsy, Lumbar Puncture
CDC Split Type: CO3525

Write-up: Pt admit to hosp w/encephalitis & optic neuritis on 25-MAR-90. Brain biopsy consistent w/post viral or post immunization. Viral titers pending 5th DTP no prior problems. No known drug allergies. Pt has milk allergy.


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