| VAERS ID: |
69269 (history) |
| Form: |
Version .0 |
| Age: |
0.3 |
| Sex: |
Male |
| Location: |
Virginia |
| Vaccinated: | 1993-03-23 |
| Onset: | 1993-04-01 |
| Days after vaccination: | 9 |
| Submitted: |
0000-00-00 |
| Entered: |
1994-12-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
324952 / 2 |
RL / - |
| HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
MSSS5D / 2 |
LL / - |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
667M / 2 |
MO / PO |
Administered by: Military Purchased by: Military
Symptoms: Agitation,
Convulsion,
Crying,
Hypertonia,
Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)
Life Threatening? Yes
Birth Defect?
Died?
Permanent Disability? Yes
Recovered? No
Office Visit?
ER Visit? Yes
ER or Doctor Visit?
Hospitalized? Y
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: pt recvd vax; devel szs; lethargic; screaming; tense muscles; beginning after 1 wk till date of admission to hosp; in hosp approx 45 days; shunt placed; |
