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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 30860

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Case Details

VAERS ID: 30860 (history)  
Form: Version .0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-04-22
Onset:1991-04-22
   Days after vaccination:0
Submitted: 1991-05-09
   Days after onset:17
Entered: 1991-06-03
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0B21044 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M115HA / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD 841212 / 1 A / SC

Administered by: Private       Purchased by: Unknown
Symptoms: AGITATION, FEVER
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever to 106 & mild irritability several hrs p/immun; Given acetaminophen; In office the following morning temp 101, exam otherwise normal;


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