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This is VAERS ID 26004

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26004
VAERS Form:
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0438S / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: DYSPNEA, EDEMA FACE, ASTHMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type': no hx of dru allergies,

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 12/8/2009

VAERS ID: 26004 Before After
VAERS Form:
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1991-03-13 1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0438S / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema, DYSPNEA, EDEMA FACE, ASTHMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type': no hx of dru allergies, (blank)

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 5/14/2017

VAERS ID: 26004 Before After
VAERS Form:
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 9/14/2017

VAERS ID: 26004 Before After
VAERS Form:(blank) 1
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 2/14/2018

VAERS ID: 26004 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 6/14/2018

VAERS ID: 26004 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 8/14/2018

VAERS ID: 26004 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 9/14/2018

VAERS ID: 26004 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


Changed on 10/14/2018

VAERS ID: 26004 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-12
Onset:1990-09-12
Submitted:0000-00-00
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC 'Split Type':

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26004&WAYBACKHISTORY=ON


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