| 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; |
