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This is VAERS ID 26835

Case Details

VAERS ID: 26835 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Texas  
Vaccinated:1990-11-15
Onset:1990-11-16
   Days after vaccination:1
Submitted: 1990-11-20
   Days after onset:4
Entered: 1990-11-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


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