VAERS ID: |
25508 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-05-21 |
Onset: | 1990-05-21 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2357R / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Asthma,
Urticaria SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: hives, wheezing, asthma |