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From the 4/8/2021 release of VAERS data:

This is VAERS ID 134756



Case Details

VAERS ID: 134756 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2000-01-05
Onset:2000-01-05
   Days after vaccination:0
Submitted: 2000-03-06
   Days after onset:61
Entered: 2000-03-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998229 / 2 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1483J / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Brain oedema, Coma, Confusional state, Convulsion, Delirium, Dyspnoea, Encephalopathy, Hemiplegia, Infection, Pyrexia, Speech disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 42 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: RSV infection
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: MRI brain-diffuse abn white matter, LP (2) both nml, Viral culture, Toxicology test on blood-neg, electrolytes-nml, elevated Creatine Kinase-7,000, serum organic acid & amino acid analysis-nml.
CDC Split Type:

Write-up: Pt brought to ER w/fever of 106, 3 hrs post/vax. Pt became delirious. By the next AM, pt had a seizure & was transferred to other hosp & admitted. Put on respirator & managed for encephalopathy & cerebral edema. MRI abnormal & pt w/RSV.60 day follow-up dated 11/01/00 states the pt is fully recovered, but MRI of brain shows some resigual abnormality.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=134756


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