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This is VAERS ID 26963

Case Details

VAERS ID: 26963 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Indiana  
Vaccinated:1990-09-25
Onset:1990-10-05
   Days after vaccination:10
Submitted: 1990-12-06
   Days after onset:62
Entered: 1990-12-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


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