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This is VAERS ID 27521

Case Details

VAERS ID: 27521 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: California  
Vaccinated:1991-01-15
Onset:1991-01-15
   Days after vaccination:0
Submitted: 1991-01-16
   Days after onset:1
Entered: 1991-01-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295973 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 36560 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Injection site oedema, Injection site reaction, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
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: Immediate rxn, moderate erythema & local swelling size of small orange, ice applied given Tylenol. Rxn at DPT site, HIB site & Hepatitis B site - same rxn for all, same tmt.


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