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This is VAERS ID 47526

Case Details

VAERS ID: 47526 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Wisconsin  
Vaccinated:1992-05-07
Onset:1992-05-09
   Days after vaccination:2
Submitted: 1992-07-07
   Days after onset:59
Entered: 1992-11-30
   Days after submission:146
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M665HH / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703T / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Asthenia, Diarrhoea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: mom knows lab work done-unsure what tests;
CDC Split Type: WI92054

Write-up: diarrhea, vomiting; rash tha came & went around neck & diaper area; tired; no blood in stool; poor appetite; no headache; no seizures; seen by MD:


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