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This is VAERS ID 28763

Case Details

VAERS ID: 28763 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Nebraska  
Vaccinated:1991-02-19
Onset:1991-02-20
   Days after vaccination:1
Submitted: 1991-02-21
   Days after onset:1
Entered: 1991-03-04
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Gaze palsy, Otitis media, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC Split Type: NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


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