National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 28903

Government Disclaimer on use of this data



Case Details

VAERS ID: 28903 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-02-05
Onset:1991-02-05
   Days after vaccination:0
Submitted: 1991-02-06
   Days after onset:1
Entered: 1991-03-08
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC Split Type: PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=28903


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166