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This is VAERS ID 25137

Case Details

VAERS ID: 25137 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Virginia  
Vaccinated:1990-05-28
Onset:1990-05-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 05595/2414R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277943 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.


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