VAERS ID: |
25870 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-08-24 |
Onset: | 1990-08-25 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
279947 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
61706 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Pyrexia,
Stupor SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV became irritable, body temp 100.f. No vomiting or other symptoms; Fell asleep at 6AM when parents went to wake him for feeding noted to be unresponsive. Paramedics were called brought to ER. |