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This is VAERS ID 25912

Case Details

VAERS ID: 25912 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alaska  
Vaccinated:1990-06-08
Onset:1990-06-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B11061 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0605H / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: elevated temperature of 103+, projectile vomitting, continued high pitched crying. Medical examination by treating physician & released.


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