| VAERS ID: |
25682 (history) |
| Form: |
Version 1.0 |
| 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 / UNK |
- / 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 conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ~ ()~~~In patient
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. |
