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From the 12/31/2003 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 30355

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Case Details

VAERS ID: 30355 (history)  
Form: Version .0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1991-01-28
Onset:0000-00-00
Submitted: 1991-03-19
Entered: 1991-05-14
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0F11073 / 2 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD - / - - / PO

Administered by: Military       Purchased by: Unknown
Symptoms: URTICARIA
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NONE

Write-up: Urticarial rash - hives trunk & neck;


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