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This is VAERS ID 25863

Case Details

VAERS ID: 25863 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: New York  
Vaccinated:1990-08-28
Onset:1990-09-02
   Days after vaccination:5
Submitted: 1990-09-04
   Days after onset:2
Entered: 1990-09-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15245 / 2 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Face oedema, Rash
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/OPV developed erythematous papular rash on abdomen, face swollen, rash occured 5 days after vaccine, tx benadryl, icepacks.


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