| 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; |
