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This is VAERS ID 27753

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 27753 (history)  
Form: Version 1.0  
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 conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Diagnostic Lab Data: SGOT elevated at 125, SPGT elevated at 137, LDH elevated at 527 CPK elevated at 808. Urinalysis showed .1% glucose & trace protein.
CDC Split Type:

Write-up: Febrile exanthem; 4 days prior to admission nausea, vomiting & diarrhea. 1 day prior to admission generalized erythematous rash beginning on extremities & progressing to trunk; Epistaxis & rhinorrhea w/mild cough. Febrile to 101.9; Conjuct.

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