National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/7/2022 release of VAERS data:

This is VAERS ID 103870

Government Disclaimer on use of this data



Case Details

VAERS ID: 103870 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1997-09-16
Onset:1997-09-17
   Days after vaccination:1
Submitted: 1997-10-09
   Days after onset:22
Entered: 1997-10-27
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=103870


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166