National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 35663

Case Details

VAERS ID: 35663 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-10
Onset:1991-09-20
   Days after vaccination:10
Submitted: 1991-09-24
   Days after onset:4
Entered: 1991-10-21
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Meningitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC Split Type: LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=35663


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166