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This is VAERS ID 39572

Case Details

VAERS ID: 39572 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:1990-07-27
Onset:1990-08-03
   Days after vaccination:7
Submitted: 1991-06-07
   Days after onset:308
Entered: 1992-02-18
   Days after submission:256
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283913 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0436S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0606D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal distension, Anorexia, Arthralgia, Hypotonia, Infection, Meningitis, Paralysis, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 120 days
   Extended hospital stay? No
Previous Vaccinations: pt had no hx of prior vax;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: dx poss viral meningitis;
CDC Split Type: CA9216

Write-up: 2 days prior immun pt devel apparently moderate fever (temp not taken) which fluctuated; 7 days post vax pt exp loss of appetite was listless & c/o inability to walk; wrists, ankles & feet hurting; body was flaccid & abdo was distended;


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