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This is VAERS ID 25611

Case Details

VAERS ID: 25611 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-06-29
Onset:1990-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Conduction defects (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), 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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC Split Type: WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


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