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This is VAERS ID 634198

Case Details

VAERS ID: 634198 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:2016-05-02
Onset:2016-05-02
   Days after vaccination:0
Submitted: 2016-05-03
   Days after onset:1
Entered: 2016-05-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS H53CL / UNK LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L031098 / UNK RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Listless, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergy to Amox (rash)
Allergies:
Diagnostic Lab Data: None needed
CDC Split Type:

Write-up: Fever to 105 this morning, decreased to 100.4 after several hours, no treatment given. Also listless.


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