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This is VAERS ID 25033

Case Details

VAERS ID: 25033 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Illinois  
Vaccinated:1990-06-25
Onset:1990-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271912 / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: 16May90 Oral polio vaccine Lederle 265-927
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated temp (as high as 104.3), headache, vomiting, irritable 40 hours.


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