| VAERS ID: |
25003 (history) |
| Form: |
Version 1.0 |
| Age: |
0.8 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 1990-01-29 |
| Onset: | 1990-02-04 |
| Days after vaccination: | 6 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium,
Hypokinesia,
Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
