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This is VAERS ID 45957

Case Details

VAERS ID: 45957 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Arkansas  
Vaccinated:1992-07-09
Onset:1992-07-19
   Days after vaccination:10
Submitted: 1992-07-22
   Days after onset:3
Entered: 1992-10-01
   Days after submission:71
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322913 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HK / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0144V / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Pyrexia, Rash
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), Hypersensitivity (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, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR9243

Write-up: elevated temp & rash on neck starting 19JUL92 temp went to 105.8 had sz; hospitalized over noc; mom states WBC WNL; d/c 20JUL92 had DTP/OPV/HIB/MMR/TB Tine 9JUL92; MD felt related to vax;


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