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This is VAERS ID 110712

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

Case Details

VAERS ID: 110712 (history)  
Form: Version .0  
Age: 23.3  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-01-15
Onset:1998-01-30
   Days after vaccination:15
Submitted: 1998-05-05
   Days after onset:94
Entered: 1998-05-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED, ADULT MASS. DPH. / MASS. DPH TD61 / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: CONVULS, REACT AGGRAV
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities
CDC Split Type: epilepsy

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=110712


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