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This is VAERS ID 25004

Case Details

VAERS ID: 25004 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Male  
Location: New York  
Vaccinated:1989-11-13
Onset:1989-11-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 232961 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Dermatitis contact, Oedema genital, Pelvic pain
SMQs:, Angioedema (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890269201

Write-up: Pt developed chills for approx. 1 hr, felt achy all over, genital area turned red with some swelling, no pain 24 hrs later, now has pain in genital area. Genitals pain, swelling, redness for 8 days. Fever, dematitis contact, rigors


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