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This is VAERS ID 25780

Case Details

VAERS ID: 25780 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maryland  
Vaccinated:1990-07-26
Onset:1990-07-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-07-29
   Days after onset: 1
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC Split Type: 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


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