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This is VAERS ID 26004

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

Case Details

VAERS ID: 26004 (history)  
Form: Version .0  
Age: 10.0  
Sex: Female  
Location: Illinois  
Vaccinated:1990-09-12
Onset:1990-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0438S / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: ASTHMA, DYSPNEA, EDEMA FACE
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC Split Type: no hx of dru allergies,

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26004


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