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This is VAERS ID 29507

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 29507 (history)  
Form: Version .0  
Age: 1.7  
Sex: Male  
Location: Oregon  
Vaccinated:1991-03-12
Onset:1991-03-13
   Days after vaccination:1
Submitted: 1991-03-20
   Days after onset:7
Entered: 1991-04-03
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 3 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M636FN / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 0 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0626F / 2 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


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