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From the 4/23/2021 release of VAERS data:

This is VAERS ID 26317



Case Details

VAERS ID: 26317 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: New York  
Vaccinated:1990-10-10
Onset:1990-10-10
   Days after vaccination:0
Submitted: 1990-10-18
   Days after onset:8
Entered: 1990-10-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 5 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1313S / 2 - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Cough, Hypersensitivity, Rhinitis, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Anaphalaxis type rxn @ time of vacc.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated /w DTP/MMR developed acute allergic rxn involving diffuse urticaria, rhinonlea, sneezing, cough & wheezing within 60 sec of inject. Pt required Epinephrine & Diphenydramine inject.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=26317


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