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This is VAERS ID 27119

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

Case Details

VAERS ID: 27119 (history)  
Form: Version .0  
Age: 1.4  
Sex: Female  
Location: Maryland  
Vaccinated:1990-10-25
Onset:1990-10-26
   Days after vaccination:1
Submitted: 1990-11-09
   Days after onset:14
Entered: 1990-12-21
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M670FC / 0 RL / -
MMR: MMR II / MSD 13135 / 0 LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: ATAXIA, FEVER, RASH MAC PAP
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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-Negative; CT Scan - Normal
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed acute cerebella ataxia, maculopapular rash, fever of 102.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27119


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