VAERS ID: 100118

AGE: 0.2| SEX: M|STATE: SD (United States)

Description

4DEC96 1115PMM t99.2, rash, diarrhea;dx gastritis, conjuncitivis;5DEC96 235PM t99.9, vomiting noc w/temp up to 103 -104ax, not wanting to eat;FNP noted weak crys;responsive to stimulip;pt referred to MD;

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Symptoms

Rash, Anorexia, Pyrexia, Vomiting, Diarrhoea, Conjunctivitis, Crying, Gastritis

Vaccines

VAX DATE: 12-03-1996| ONSET DATE: 12-04-1996| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
POLIO VIRUS, ORAL (ORIMUNE) 1 OPV PFIZER\WYETH 438648 PO MO
DTP + HIB (TETRAMUNE) 1 DTPHIB PFIZER\WYETH 439194 IM LL
HEP B (RECOMBIVAX HB) 2 HEP MERCK & CO. INC. 0516D IM RL

RECVDATE:07-10-1997
RPT_DATE:12-24-1996
CAGE_YR:0
CAGE_MO:0.2
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PUB
OTHER_MEDS:Dimetapp;APAP
CUR_ILL:URI, heat rash, diaper rash;
HISTORY:(33 week gestation);was preterm w/pulmonary problems following by apnea;
PRIOR_VAX:NA~ ()~~~In patient
SPLTTYPE:SD97007
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:PUB

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