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This is VAERS ID 105194

Case Details

VAERS ID: 105194 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: New York  
Vaccinated:1997-11-06
Onset:1997-11-09
   Days after vaccination:3
Submitted: 1997-11-21
   Days after onset:12
Entered: 1997-11-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978218 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-09
   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:
Current Illness: NONE
Preexisting Conditions: hydroencephaly, shunted hydrocephalis, cerebral palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severely delayed child became lethargic;48hr p/vax brought to ED, expired during CT scan to evaluate shunt status;


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