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This is VAERS ID 39056

Case Details

VAERS ID: 39056 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1991-09-06
Onset:1991-09-12
   Days after vaccination:6
Submitted: 1992-01-17
   Days after onset:127
Entered: 1992-01-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC Split Type: NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


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