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This is VAERS ID 85024

Case Details

VAERS ID: 85024 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Texas  
Vaccinated:1996-03-21
Onset:1996-03-22
   Days after vaccination:1
Submitted: 1996-03-25
   Days after onset:3
Entered: 1996-04-22
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC Split Type: 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


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