| VAERS ID: |
25696 (history) |
| Form: |
Version 1.0 |
| Age: |
1.8 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 1990-05-14 |
| Onset: | 1990-05-15 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-08-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
OB11061 / UNK |
- / IM L |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0890S / UNK |
- / IM L |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Injection site pain,
Injection site reaction,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Ear infection took Ceclor 5/7 -5/14
Preexisting Conditions: Infectious Mono in January 1990
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt vaccinated with DTP/MMR/OPV and developed a fever of 104.2; Temp decreased with tylenol and ice pack; Pain and swelling of leg site | 