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This is VAERS ID 39160

Case Details

VAERS ID: 39160 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: California  
Vaccinated:1991-04-11
Onset:1991-04-21
   Days after vaccination:10
Submitted: 1992-01-20
   Days after onset:274
Entered: 1992-01-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 1 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC Split Type:

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


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