Report #2836341

Received Apr 16, 2025

ER / ED visit

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Female
Age: 4 yrs
State: MI
Recovered: Recovered
Vaccinated: Apr 3, 2025
Onset: Apr 3, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
DTAPIPV	DTAP + IPV (KINRIX)	GLAXOSMITHKLINE BIOLOGICALS	5	YN2X2	IM / RL
MMRV	MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)	MERCK & CO. INC.	UNK	Y013573	IM / LL

Symptoms (7)

Abdominal pain upperAnaphylactic reactionEye movement disorderLoss of consciousnessScreamingUrticariaVomiting

Symptom narrative

10min after receiving vaccine started screaming that stomach hurt. Vomited and eyes rolled back into head and had LOC. started developing hives over entire body. Rushed her to ER where two doses of epinepherine were administered for anaphylaxis.

Current illness

none

Medical history

speech delay, developmental delay, astigmatism

Other medications

none

Allergies

nkda

Lab data

ER visit immediately following vaccine administration