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This is VAERS ID 33018

Case Details

VAERS ID: 33018 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-05-22
Onset:1990-05-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0489S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coordination abnormal, Haemorrhage, Hypokinesia, Injection site mass, Injection site pain, Subcutaneous nodule, Vascular anomaly
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray - soft tissue mass.
CDC Split Type: WAES90051200

Write-up: 22May90 pt vax; devel firm, sore, tender, egglike mass in triceps area. 24May90 xray revealed the mass to be soft tissue density arising from triceps muscle mass. One week later pt was fussy & more clumsy than usual. See worm..


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