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This is VAERS ID 69269


VAERS ID: 69269 (history)  
Form: Version .0  
Age: 0.3  
Gender: 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:, 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)

Life Threatening? Yes
Birth Defect?
Died?
Permanent Disability? Yes
Recovered? No
Office Visit?
ER Visit? Yes
ER or Doctor Visit?
Hospitalized? Y
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;


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