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This is VAERS ID 27119

Case Details

VAERS ID: 27119 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Maryland  
Vaccinated:1990-10-25
Onset:1990-10-26
   Days after vaccination:1
Submitted: 1990-11-09
   Days after onset:14
Entered: 1990-12-19
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13135 / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-Negative; CT Scan - Normal
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed acute cerebella ataxia, maculopapular rash, fever of 102.


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