| VAERS ID: |
25492 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Male |
| Location: |
Iowa |
| Vaccinated: | 1990-06-15 |
| Onset: | 1990-06-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
279947 / UNK |
- / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
275933 / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Agitation,
Hypotonia,
Pallor
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: limp, pale, excessive irritability hypotonic |
