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This is VAERS ID 25236

Case Details

VAERS ID: 25236 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-06-04
Onset:1990-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 08905 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Face oedema
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? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: given Benadryl /p vaccine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 hr /p receiving Td & MMR returned to DHC /w swollen itching eyes, no respiratory distress, treated /w Benadryl 50 mg


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