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This is VAERS ID 28123

Case Details

VAERS ID: 28123 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Oklahoma  
Vaccinated:1990-02-06
Onset:1990-02-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1334R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0599B / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No illness following previous immunization.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 900162803

Write-up: CDC reports: 17 mo child developed a rash following DTP/OPV/MMR immun; Hospitalized 1 day.


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