This is VAERS ID 25542

Administered by: Private       Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 9001111.01

Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971