VAERS ID: 25033

AGE: 5| SEX: M|STATE: IL (United States)

Description

Elevated temp (as high as 104.3), headache, vomiting, irritable 40 hours.

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Symptoms

Agitation, Pyrexia, Headache, Vomiting

Vaccines

VAX DATE: 06-25-1990| ONSET DATE: 06-25-1990| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
DTP (TRI-IMMUNOL) 0 DTP LEDERLE LABORATORIES 271912 IM

RECVDATE:07-09-1990
RPT_DATE:
CAGE_YR:4
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:16May90 Oral polio vaccine Lederle 265-927
CUR_ILL:
HISTORY:
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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