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This is VAERS ID 26969

Case Details

VAERS ID: 26969 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: California  
Vaccinated:1990-11-16
Onset:1990-11-20
   Days after vaccination:4
Submitted: 1990-11-20
   Days after onset:0
Entered: 1990-12-12
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 383970 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11835 / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Malaise, Oedema, Pain, Pyrexia, Somnolence
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: CA9013

Write-up: Pt vaccinated with MMR/DTP would not be allowed to be put down & won''t walk, listless, sleepy all the time, fever, soreness & swelling gone w/Tylenol.


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