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This is VAERS ID 27753

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27753
VAERS Form:
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1342S / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, DIARRHEA, COUGH INC, CONJUNCTIVITIS, EPISTAXIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     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


Changed on 12/8/2009

VAERS ID: 27753 Before After
VAERS Form:
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-07 1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1342S / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting, FEVER, DIARRHEA, COUGH INC, CONJUNCTIVITIS, EPISTAXIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     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


Changed on 5/14/2017

VAERS ID: 27753 Before After
VAERS Form:
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none Seldane in the summer
Current Illness: physical revealed neg Rubella titer
Preexisting Conditions: none Hayfever, sinus problems
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 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: 5 Febrile exanthem; 4 days /p recving MMR, pt developed prior to admission nausea, vomiting, diarrhea, 3 days later developed vomiting & diarrhea. 1 day prior to admission generalized erythematous rash beginning on extrem.& trunk,pt described epistaxis&rhinorrhea.Admit hosp 9 days /p vax,febrile,dehydrated. Orpharynx erythematous/w shallow ulcer extremities & progressing to trunk; Epistaxis & rhinorrhea w/mild cough. Febrile to 101.9; Conjuct.


Changed on 9/14/2017

VAERS ID: 27753 Before After
VAERS Form:(blank) 1
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
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.


Changed on 2/14/2018

VAERS ID: 27753 Before After
VAERS Form:1
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
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.


Changed on 6/14/2018

VAERS ID: 27753 Before After
VAERS Form:1
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
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.


Changed on 8/14/2018

VAERS ID: 27753 Before After
VAERS Form:1
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
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.


Changed on 9/14/2018

VAERS ID: 27753 Before After
VAERS Form:1
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
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.


Changed on 10/14/2018

VAERS ID: 27753 Before After
VAERS Form:1
Age:33.0
Sex:Male
Location:Michigan
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted:1991-01-28
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
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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