VAERS ID: |
28434 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1990-12-17 |
Onset: | 1990-12-30 |
Days after vaccination: | 13 |
Submitted: |
1991-01-22 |
Days after onset: | 23 |
Entered: |
1991-02-25 |
Days after submission: | 34 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M030FC / 1 |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0896S / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Cellulitis,
Conjunctivitis,
Eye disorder,
Infection SMQs:, Severe cutaneous adverse reactions (broad), Corneal disorders (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: Current Illness: none Preexisting Conditions: hx of recurring otitis;croup Allergies: Diagnostic Lab Data: blood cultures CDC Split Type: CO916
Write-up: Lt eye swelling /w rapid progression on 31Dec. Taken to ER & subsequently hospitalized /w orbital cellulitis. Blood cultures showed hemophaelis influenzae |