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This is VAERS ID 83750

Case Details

VAERS ID: 83750 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: South Carolina  
Vaccinated:1996-02-28
Onset:1996-02-28
   Days after vaccination:0
Submitted: 1996-02-29
   Days after onset:1
Entered: 1996-03-19
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0619B / 2 - / SC
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 398904 / 5 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn in 1994 w/measles dose 2~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: SC96011

Write-up: father & stepmom states pt devel welts all over body (systemic rxn) by 4PM on the afternoon inj given;past records indicated a measles vax given in 1983 & father states had no rxn from inj;pt wasn''t taken to MD;


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