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This is VAERS ID 25617

Case Details

VAERS ID: 25617 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Texas  
Vaccinated:1990-06-11
Onset:1990-06-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


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