| VAERS ID: |
25137 (history) |
| Form: |
Version 1.0 |
| Age: |
5.0 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 1990-05-28 |
| Onset: | 1990-05-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
262913 / UNK |
- / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
05595/2414R / UNK |
- / - |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277943 / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia,
Hypotension,
Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS. |
