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This is VAERS ID 25922

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 25922 (history)  
Form: Version .0  
Age: 1.3  
Sex: Male  
Location: Ohio  
Vaccinated:1990-08-14
Onset:1990-08-24
   Days after vaccination:10
Submitted: 1990-09-08
   Days after onset:15
Entered: 1990-09-20
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M205EP / - A / SC
MMR: MMR II / MSD 1494S / - A / SC

Administered by: Private       Purchased by: Unknown
Symptoms: CONVULS, FEVER, PALLOR, RASH, RASH MAC PAP
SMQs:

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? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=25922


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