| VAERS ID: |
43649 (history) |
| Form: |
Version 1.0 |
| Age: |
1.8 |
| Sex: |
Male |
| Location: |
Kansas |
| Vaccinated: | 1992-05-18 |
| Onset: | 1992-05-28 |
| Days after vaccination: | 10 |
| Submitted: |
1992-06-03 |
| Days after onset: | 6 |
| Entered: |
1992-07-21 |
| Days after submission: | 48 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
312934 / 3 |
RL / IM |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
140HJ / 1 |
LL / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1141T / 1 |
LA / SC |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
312925 / 3 |
MO / PO |
Administered by: Public Purchased by: Public
Symptoms: Convulsion,
Hypochromic anaemia,
Pharyngitis,
Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Oropharyngeal infections (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KS92046
Write-up: 27MAY92 fever; 28MAY92 fever up to 105 a; 1030PM pt had sz in bed; taken to ER; 2AM spinal tap-?mengitis; Spinal tap-OK; red throat; ears OK; hemoglobin 8gm; |
