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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), Immune-mediated/autoimmune disorders (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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