| VAERS ID: |
25826 (history) |
| Form: |
Version 1.0 |
| Age: |
5.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 1990-08-26 |
| Onset: | 1990-08-28 |
| Days after vaccination: | 2 |
| Submitted: |
1990-08-30 |
| Days after onset: | 2 |
| Entered: |
1990-09-04 |
| Days after submission: | 5 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271915 / UNK |
RA / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
06962 / 2 |
LA / SC |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
00052004 / 5 |
MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Cough,
Injection site mass,
Injection site reaction,
Productive cough,
Pyrexia,
Rhinitis,
Vasodilatation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI 1 wk befor by hx reveals after react
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Area around DTP 6cm X 7cm rash w/ hyperthermia elevated fever 101 27AUG90, by 28AUG90 warm soaks, upper arm erythema - cold compress gone by 29AUG90; Cough with clear nasal drainage fever 103.5by 28AUG90. 29AUG90 a febrile cough decreased. |
