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This is VAERS ID 31362

Case Details

VAERS ID: 31362 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Georgia  
Vaccinated:1991-05-08
Onset:1991-05-11
   Days after vaccination:3
Submitted: 1991-06-05
   Days after onset:25
Entered: 1991-06-17
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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, 6 days
   Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


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