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This is VAERS ID 26626

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 26626 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-11-07
Onset:1990-11-07
   Days after vaccination:0
Submitted: 1990-11-08
   Days after onset:1
Entered: 1990-11-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis
SMQs:, Agranulocytosis (broad), Convulsions (narrow), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=26626


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