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This is VAERS ID 26027

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 26027 (history)  
Form: Version .0  
Age: 1.4  
Sex: Male  
Location: Illinois  
Vaccinated:1990-09-12
Onset:1990-09-12
   Days after vaccination:0
Submitted: 1990-09-13
   Days after onset:1
Entered: 1990-09-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M030FC / - A / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1705S / 0 A / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Anorexia, Injection site reaction, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no previous reaction
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shot lt arm red, the day /p red streak from shot to elbow, throwing up. Won''t eat or anything. Real cranky, erythematous skin, Rxn to MMR


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