VAERS ID: |
25819 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1990-06-15 |
Onset: | 1990-06-26 |
Days after vaccination: | 11 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1227S / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Arthritis,
Back pain,
Malaise,
Pharyngitis,
Pyrexia SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: Juvenile rheumatoid arthritis Allergies: Diagnostic Lab Data: CDC Split Type: WAES90080353
Write-up: Pt with juvenile rheumatoid arthritis vaccinated with MMR developed body aches, fever, sore throat, back pain, and arthritic symptoms which were thought to be a recurrence of juvenile rhematoid arthritis. |