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This is VAERS ID 31372

Case Details

VAERS ID: 31372 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Carolina  
Vaccinated:1990-07-19
Onset:1990-07-19
   Days after vaccination:0
Submitted: 1991-06-04
   Days after onset:320
Entered: 1991-06-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Hypertonia, Mental retardation severity unspecified, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


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