VAERS ID: 25006

AGE: 16| SEX: F|STATE: OH

Description

16 yr old female feeling faint & then had seizure within a few min. /p Td/MMR immunization. MD is uncertain if seizure was due to hyperventilation episode. No treatment initiated. Pt asymptomatic. Vaccine given routine

Symptoms

Convulsion, Dizziness

Vaccines

VAX DATE: 11-17-1989| ONSET DATE: 11-17-1989| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
MEASLES + MUMPS + RUBELLA (NO BRAND NAME) Unknown MMR Unknown Unknown Unknown
TD ADSORBED (NO BRAND NAME) Unknown TD LEDERLE LABORATORIES 247953 IM Unknown

RECVDATE:07-02-1990
RPT_DATE:
CAGE_YR:16
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:no hx of local or systemic rxns
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:890278001
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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