From the 12/8/2009 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:	1990-08-21

Vaccination / Manufacturer	Lot / Dose	Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC.	1226S / -	- / IM

Administered by: Private Purchased by: Unknown
Symptoms: Conjunctivitis, Pyrexia, Rash, Rash maculo-papular, Stevens-Johnson syndrome, Stomatitis
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal lesions, non-neoplastic, non-infectious and non-allergic (narrow), Conjunctival disorders (narrow), Ocular infections (broad)

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: WAES90070926

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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