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This is VAERS ID 29941

Case Details

VAERS ID: 29941 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Georgia  
Vaccinated:1991-01-28
Onset:1991-01-28
   Days after vaccination:0
Submitted: 1991-02-14
   Days after onset:17
Entered: 1991-04-16
   Days after submission:60
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


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