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This is VAERS ID 26102

Case Details

VAERS ID: 26102 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1990-08-21
Onset:1990-09-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC Split Type:

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


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