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From the 12/8/2009 release of VAERS data (an older release, current is 4/30/2021):

This is VAERS ID 25648



Case Details

VAERS ID: 25648 (history)  
Form: Version .0  
Age: 1.5  
Sex: Female  
Location: Texas  
Vaccinated:1989-11-17
Onset:1989-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / - - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES - / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Pallor, Pyrexia, Stupor, Visual disturbance
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no prior history on rxn''s
Allergies:
Diagnostic Lab Data:
CDC Split Type: 8902745.01

Write-up: Pt received ORIMUNE, DTP, PROHIBIT and was not focusing, in a daze, pale but not rigidly seizing. Seen in ER was febrile. Hospitalized for observation & placed on monitor. MD impression is seizure.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=25648


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