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This is VAERS ID 31770

Case Details

VAERS ID: 31770 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Alaska  
Vaccinated:1991-05-21
Onset:1991-05-24
   Days after vaccination:3
Submitted: 1991-05-28
   Days after onset:4
Entered: 1991-06-27
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC Split Type: AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


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