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This is VAERS ID 31639

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 31639 (history)  
Form: Version 1.0  
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 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 1 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), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180814&IDNUMBER=31639


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