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This is VAERS ID 27753

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

Case Details

VAERS ID: 27753 (history)  
Form: Version .0  
Age: 33.0  
Sex: Male  
Location: Michigan  
Submitted: 1991-01-28
Entered: 1991-02-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal lesions, non-neoplastic, non-infectious and non-allergic (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Ocular infections (broad)

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
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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