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This is VAERS ID 25925

Case Details

VAERS ID: 25925 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-08-30
Onset:1990-08-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / UNK - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Amnesia, Confusional state, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: previously very fearful of injections (IV or blood drawing)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had syncopal episode /p MMR shot. Subsequently had amnesia & disorientation. Could not remember place or time initially. 20 hrs /p the shot, the period of amnesia was from the injection until nightfall approx. 4-6 hrs.


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