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From the 12/31/2003 release of VAERS data (an older release, current is 4/30/2021):

This is VAERS ID 25163



Case Details

VAERS ID: 25163 (history)  
Form: Version .0  
Age: 0.0  
Sex: Male  
Location: Illinois  
Vaccinated:1990-01-03
Onset:1990-01-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 262912 / - NA / IM
OPV: ORIMUNE / LEDERLE 256923(0598E) / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: SOMNOLENCE, VOMIT
SMQs:

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=25163


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