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This is VAERS ID 26020

Case Details

VAERS ID: 26020 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Illinois  
Vaccinated:1990-09-04
Onset:1990-09-05
   Days after vaccination:1
Submitted: 1990-09-14
   Days after onset:9
Entered: 1990-09-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


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