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This is VAERS ID 26914

Case Details

VAERS ID: 26914 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-09-21
Onset:1990-09-21
   Days after vaccination:0
Submitted: 1990-12-04
   Days after onset:74
Entered: 1990-12-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1696S / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G21157 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Rash, Urticaria
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? Yes
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: AL900004

Write-up: Pt vaccinated with TD/MMR developed a rash & hives all over body following immunization. She was seen by the MD & dx as having allergic event.


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