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This is VAERS ID 29856

Case Details

VAERS ID: 29856 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Vermont  
Vaccinated:1991-01-21
Onset:1991-01-29
   Days after vaccination:8
Submitted: 1991-04-04
   Days after onset:65
Entered: 1991-04-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1502S / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: bilat serous otitis media
Preexisting Conditions: 10m, 33 wks gestation, GER, PDA repaired, microcyst,develop-delay
Allergies:
Diagnostic Lab Data: EEG-nl
CDC Split Type:

Write-up: Febrile seizure 29Jan91, hospitalized, did well


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