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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 25682

Case Details

VAERS ID: 25682 (history)  
Form: Version .0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:1990-07-06
Onset:1990-07-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1226S / - - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: CONJUNCTIVITIS, FEVER, RASH, RASH MAC PAP, STEVENS JOHNSON SYND
SMQs:

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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cortisporin otic dr., polymyxin B sulf-neomycin, sulf-hydrocortison, alcohol-propylene, glycol-polysorbate-80-thimerosal
Current Illness: external otitis
Preexisting Conditions: otitis, recurrent external
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated /w MMR 2 wks following vaccination pt developed Stevens-Johnson syndrome & was hospitalized. 17Jul90 developed rash on chest,trunk, palms of the hands, face & upper & lower extremities. Low grade fever /w cracked lips & mouth.


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