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This is VAERS ID 25012

Case Details

VAERS ID: 25012 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1989-10-20
Onset:1989-10-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 253963 / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypotonia, Monoplegia, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
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: xrays of left shoulder, clavicle, humerus & forearm - WNL
CDC Split Type: 890255101

Write-up: 3 days /p immun. infant only able to move fingers of left arm, no tone in arm. Immun. given in Right thigh/buttocks. Mononeuropathy left upper extremity.


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