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From the 1/14/2022 release of VAERS data:

This is VAERS ID 30008

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Case Details

VAERS ID: 30008 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Idaho  
Vaccinated:1991-01-17
Onset:1991-01-24
   Days after vaccination:7
Submitted: 1991-02-06
   Days after onset:13
Entered: 1991-04-22
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Haemorrhage, Hypertonia, Somnolence, Stupor, Vasodilatation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


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