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This is VAERS ID 25682

Case Details

VAERS ID: 25682 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:1990-07-06
Onset:1990-07-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1226S / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Conjunctivitis, Pyrexia, Rash, Rash maculo-papular, Stevens-Johnson syndrome, Stomatitis
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cortisporin otic dr., polymyxin B sulf-neomycin, sulf-hydrocortison, alcohol-propylene, glycol-polysorbate-80-thimerosal
Current Illness: external otitis
Preexisting Conditions: otitis, recurrent external
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES90070926

Write-up: Pt vaccinated /w MMR 2 wks following vaccination pt developed Stevens-Johnson syndrome & was hospitalized. 17Jul90 developed rash on chest,trunk, palms of the hands, face & upper & lower extremities. Low grade fever /w cracked lips & mouth.


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