VAERS ID: |
25780 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-07-26 |
Onset: | 1990-07-28 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-07-29
Days after onset: 1
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: No previous seizures in pt. No hx of seizures in parents and/or siblings. Allergies: Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested CDC Split Type: 9001336.01
Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival. |