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This is VAERS ID 26078

Case Details

VAERS ID: 26078 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:1990-08-16
Onset:1990-08-16
   Days after vaccination:0
Submitted: 1990-09-17
   Days after onset:32
Entered: 1990-09-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / UNK - / A

Administered by: Private       Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


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