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This is VAERS ID 27753

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

Case Details

VAERS ID: 27753 (history)  
Form: Version .0  
Age: 33.0  
Sex: Male  
Location: Michigan  
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted: 1991-01-28
Entered: 1991-02-07
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1342S / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: CONJUNCTIVITIS, COUGH INC, DIARRHEA, EPISTAXIS, 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: physical revealed neg Rubella titer
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 3 blood cx-neg, ASO titer-neg, WBC-7.6 on admit (31Dec), 1Jan91 WBC dec 5.2, neg-throat, stool cultures, 31Dec SGOT-125, SGPT-137, LDH-527, CPK-808
CDC Split Type:

Write-up: 5 days /p recving MMR, pt developed nausea, vomiting, diarrhea, 3 days later developed erythematous rash on extrem.& trunk,pt described epistaxis&rhinorrhea.Admit hosp 9 days /p vax,febrile,dehydrated. Orpharynx erythematous/w shallow ulcer


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