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This is VAERS ID 30930

Case Details

VAERS ID: 30930 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Oregon  
Vaccinated:1991-04-11
Onset:1991-04-11
   Days after vaccination:0
Submitted: 1991-04-17
   Days after onset:6
Entered: 1991-06-03
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 3 - / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC Split Type: OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


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