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This is VAERS ID 26298

Case Details

VAERS ID: 26298 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Arizona  
Vaccinated:1990-10-09
Onset:1990-10-10
   Days after vaccination:1
Submitted: 1990-10-10
   Days after onset:0
Entered: 1990-10-19
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11096 / UNK LL / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11202 / UNK RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9A11072 / UNK RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1500S / UNK RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 61764 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Febrile convulsion
SMQs:, Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
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: Fever 101.4 & Seizure. C/O feeling tired, has been less active than norm today. Pt had DTP, MMR, HIB, vacines yesterday.


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