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This is VAERS ID 28500

Case Details

VAERS ID: 28500 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Ohio  
Vaccinated:1991-01-22
Onset:1991-01-22
   Days after vaccination:0
Submitted: 1991-02-26
   Days after onset:35
Entered: 1991-02-28
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FH / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285948 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Grand mal convulsion
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: under investigation
CDC Split Type:

Write-up: Status epilepticus approx 60 min. Intubated. Intensive care unit.


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