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This is VAERS ID 42850

Case Details

VAERS ID: 42850 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Missouri  
Vaccinated:1992-06-02
Onset:1992-06-04
   Days after vaccination:2
Submitted: 1992-06-05
   Days after onset:1
Entered: 1992-06-15
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318909 / 3 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1662T / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0644A / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cough, Hypoglycaemia, Hypotonia, Injection site pain, Leukocytosis, Otitis media, Rhinitis, Stupor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: 5JUN on ATB for ear infection & congest
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood work-low blood sugar, white count inc; CAT Scan neg; UA-neg; 10% dextrose IV push given in ER:
CDC Split Type: MO92039

Write-up: 2JUN local discomfort; no fever; 3JUN low grade fever; coughing & clear runny nose; 4JUN awoke 10AM fussy, whimpering; laid down on kitchen floor; in car pt slump forward & was unresponsive; seen in ER: was awake w/minimal response to tests


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