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This is VAERS ID 36589

Case Details

VAERS ID: 36589 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-11-06
Onset:1991-11-15
   Days after vaccination:9
Submitted: 1991-11-18
   Days after onset:3
Entered: 1991-11-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 1 LL / IM

Administered by: Public       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC Split Type:

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


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