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This is VAERS ID 25925

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

Case Details

VAERS ID: 25925 (history)  
Form: Version .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: 1990-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1485S / - - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: AMNESIA, CONFUS, SYNCOPE
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? No
Previous Vaccinations:
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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=25925


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