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This is VAERS ID 36126

Case Details

VAERS ID: 36126 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1991-10-04
Onset:1991-10-04
   Days after vaccination:0
Submitted: 1991-10-23
   Days after onset:19
Entered: 1991-11-06
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Gaze palsy, Hypertonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC Split Type: NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


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