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This is VAERS ID 26957

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

Case Details

VAERS ID: 26957 (history)  
Form: Version .0  
Age: 1.4  
Sex: Male  
Location: Washington  
Vaccinated:1990-11-10
Onset:1990-11-19
   Days after vaccination:9
Submitted: 1990-12-01
   Days after onset:12
Entered: 1990-12-13
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PEDVAXHIB / MSD 07415 / 0 A / IM
MMR: MMR II / MSD 1492S / 0 A / SC

Administered by: Private       Purchased by: Unknown
Symptoms: CONVULS, CYANOSIS, EYES GAZE UPWARD, FEVER
SMQs:

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

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26957


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