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; |