| VAERS ID: |
83713 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 1995-04-25 |
| Onset: | 1995-05-05 |
| Days after vaccination: | 10 |
| Submitted: |
0000-00-00 |
| Entered: |
1996-03-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES |
4J51067 / 1 |
RL / IM |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M520LA / 4 |
LA / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1744W / 1 |
LL / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0707B / 4 |
MO / PO |
Administered by: Public Purchased by: Public
Symptoms: Apnoea,
Blindness,
Bradycardia,
Convulsion,
Encephalitis,
Hypoxia,
Mental retardation severity unspecified,
Myelitis
SMQs:, Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC Split Type: CO96010
Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity |
