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This is VAERS ID 31639

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 31639 (history)  
Form: Version .0  
Age: 1.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1991-06-10
Onset:1991-06-10
   Days after vaccination:0
Submitted: 1991-06-17
   Days after onset:7
Entered: 1991-06-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 0 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 0 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Leukopenia, Otitis media, Pyrexia
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC Split Type:

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=31639


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