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This is VAERS ID 264016

Case Details

VAERS ID: 264016 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2006-10-03
Onset:2006-10-04
   Days after vaccination:1
Submitted: 2006-10-04
   Days after onset:0
Entered: 2006-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B035AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0018 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1069P / 2 RL / SC

Administered by: Public       Purchased by: Private
Symptoms: Injection site oedema, Pyrexia, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: cellulitis~ ()~~0.00~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant local swelling, fever and ITP to Dtap #05


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