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This is VAERS ID 25961

Case Details

VAERS ID: 25961 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1990-08-18
Onset:1990-08-23
   Days after vaccination:5
Submitted: 1990-09-06
   Days after onset:14
Entered: 1990-09-17
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC Split Type:

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


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