VAERS ID: |
31053 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Kansas |
Vaccinated: | 1991-02-27 |
Onset: | 1991-03-08 |
Days after vaccination: | 9 |
Submitted: |
1991-03-21 |
Days after onset: | 13 |
Entered: |
1991-06-06 |
Days after submission: | 76 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11070 / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0555S / 1 |
- / SC |
Administered by: Public Purchased by: Public Symptoms: Convulsion,
Petechiae,
Pyrexia SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies:
Diagnostic Lab Data: ?pt hospitalized CDC Split Type: KS9112
Write-up: Elevated fever, sz-2x; 103R dx OM point red rash ontorso started 8MAR91-hosp 8MAR91PM 11MAR91AM; |