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This is VAERS ID 107036

Case Details

VAERS ID: 107036 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:1998-01-15
Onset:1998-01-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1998-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / UNK LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 1563E / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1801E / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, CSF test abnormal, Convulsion, Coordination abnormal, Delirium, Hypokinesia, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-01-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: mild atopic dermatitis noted on 15JAN98
Allergies:
Diagnostic Lab Data: CSF showed 37WBC, 0RBC, repeat CSF p/sz WBC 140, RBC 90;
CDC Split Type: GA98003

Write-up: pt presented to ER w/refusal to walk, ataxia, devel sz;required intubation during hosp;CT scan cerebral edema, herniation, death;


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