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This is VAERS ID 39375

Case Details

VAERS ID: 39375 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Oregon  
Vaccinated:1991-12-31
Onset:1992-01-16
   Days after vaccination:16
Submitted: 1992-01-22
   Days after onset:6
Entered: 1992-02-07
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Cough, Otitis media, Pyrexia
SMQs:, Anaphylactic reaction (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


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