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This is VAERS ID 46021

Case Details

VAERS ID: 46021 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1992-09-24
Onset:1992-09-24
   Days after vaccination:0
Submitted: 1992-09-25
   Days after onset:1
Entered: 1992-10-05
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence
SMQs:, Severe cutaneous adverse reactions (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


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