| VAERS ID: |
87228 (history) |
| Form: |
Version 1.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 1995-01-04 |
| Onset: | 1995-01-13 |
| Days after vaccination: | 9 |
| Submitted: |
1996-06-20 |
| Days after onset: | 523 |
| Entered: |
1996-06-24 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0079A / UNK |
LA / - |
| TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
4F61058 / UNK |
RA / - |
Administered by: Public Purchased by: Private
Symptoms: Arthralgia,
Arthropathy,
Hypertonia,
Hypochromic anaemia,
Hypokinesia,
Malaise,
Oedema peripheral,
Osteoarthritis
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9 days post vax inc WBC;3months post vax +RA factor;inc sed rate, inc EOS, dec hemoglobin
CDC Split Type:
Write-up: 9 days post vax fever-lt shoulder pain-APAP -saw MD;blood work;pt started on ATB;given med for shoulder;pain rt shoulder, sore throat, congestion;also hot lt great toe;MD did x-rays showed soft tissue swelling-joint pain;+RA,n,effusion knee |
