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This is VAERS ID 43259

Case Details

VAERS ID: 43259 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: New York  
Vaccinated:1992-06-22
Onset:1992-06-22
   Days after vaccination:0
Submitted: 1992-06-24
   Days after onset:2
Entered: 1992-06-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (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: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: t105, lethargy, seizures admitted to hosp;


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