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This is VAERS ID 25682

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25682
VAERS Form:
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1226S / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, RASH, RASH MAC PAP, CONJUNCTIVITIS, STEVENS JOHNSON SYND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
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':

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.


Changed on 12/8/2009

VAERS ID: 25682 Before After
VAERS Form:
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
Submitted:0000-00-00
Entered:1990-08-22 1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1226S / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Conjunctivitis, Pyrexia, Rash, Rash maculo-papular, Stevens-Johnson syndrome, Stomatitis, FEVER, RASH, RASH MAC PAP, CONJUNCTIVITIS, STEVENS JOHNSON SYND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
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': (blank) 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.


Changed on 5/14/2017

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

Administered by: Private      Purchased by: Unknown
Symptoms: Conjunctivitis, Pyrexia, Rash, Rash maculo-papular, Stevens-Johnson syndrome, Stomatitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2017

VAERS ID: 25682 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 25682 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 25682 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 25682 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 25682 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 10/14/2018

VAERS ID: 25682 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:California
Vaccinated:1990-07-06
Onset:1990-07-17
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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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