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This is VAERS ID 107036

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 107036 (history)  
Form: Version .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: 1998-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 826A2 / - LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 1563E / - RL / IM
MMR: MMR II / MSD 1801E / - LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: ATAXIA, BRAIN SYND ACUTE, CONVULS, CSF ABNORM, EDEMA BRAIN
SMQs:

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:
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:

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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