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This is VAERS ID 27096

Case Details

VAERS ID: 27096 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Montana  
Vaccinated:1990-11-14
Onset:1990-11-28
   Days after vaccination:14
Submitted: 1990-12-10
   Days after onset:12
Entered: 1990-12-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC Split Type:

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


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