| VAERS ID: |
37479 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 1991-08-22 |
| Onset: | 1991-08-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1992-06-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0977T / 1 |
- / IM |
Administered by: Other Purchased by: Other
Symptoms: CSF test abnormal,
Convulsion,
Laboratory test abnormal,
Pyrexia,
Rash,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 25AUG91 WBC Count-7100; Segemented neutrophils-21; BANDS-53; Serum glucose-75; Protein-17; Serum Magnesium-2.4; Serum calcium-9.1; LP-3WBC/HPF;
CDC Split Type: WAES91090001
Write-up: pt recvd MMR vax on 22AUG91 & 36 hrs following vax pt devel a rash & fever; also vomited once; 25AUG91 presented to ER w/tonoclonic seizure; t104.4 ax & pt was hospitalized; |
