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This is VAERS ID 131353

Case Details

VAERS ID: 131353 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:3
Submitted: 1999-11-19
   Days after onset:26
Entered: 1999-11-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, CSF test abnormal, Cardiac arrest, Coma, Confusional state, Convulsion, Electroencephalogram abnormal, Encephalitis, Headache, Infection, Laboratory test abnormal, Meningitis, Nausea, Nuchal rigidity, Paraesthesia, Pyrexia, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-11-04
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: 10/28/99 electroencephalography-severe cerebral distrubances;MRI intraparenchymatous lesions evoked dx of herpetic infect process;herpes;lyme negative;mycoplasm IG=12;10/30/99 electroenephalography-confirmed aggravation of cerebral lesions;
CDC Split Type: WAES99111051

Write-up: p/vax pt w/drowsiness & cephalagia;hosp & fever & tonic clonic convuls;no motor deficiency but paresthesia & meningism (nausea & neck stiffness);pt confused;to ICU exp cardiac & resp arrest;state IV coma;dx meningoencephalitis;pt died

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