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This is VAERS ID 33051

Case Details

VAERS ID: 33051 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: California  
Vaccinated:1990-08-16
Onset:1990-08-16
   Days after vaccination:0
Submitted: 1991-07-24
   Days after onset:342
Entered: 1991-07-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military       Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC Split Type:

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


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