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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 27604

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Case Details

VAERS ID: 27604 (history)  
Form: Version .0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1991-01-07
Onset:1991-01-07
   Days after vaccination:0
Submitted: 1991-01-23
   Days after onset:16
Entered: 1991-01-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0G11097 / 1 RL / -
IPV: POLIOVAX / CONNAUGHT LTD 841122 / 0 LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: FEVER, INJECT SITE REACT
SMQs:

Life Threatening? No
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:
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


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