VAERS ID: |
110712 (history) |
Form: |
Version 1.0 |
Age: |
23.0 |
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: |
1998-05-11 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB |
TD61 / UNK |
- / - |
Administered by: Private Purchased by: Other Symptoms: Condition aggravated,
Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
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: Other Medications: Dilantin;Tegretol Current Illness: Epilepsy Preexisting Conditions: epilepsy Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder. CDC Split Type:
Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder. |