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This is VAERS ID 25163

Case Details

VAERS ID: 25163 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:1990-01-03
Onset:1990-01-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


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