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This is VAERS ID 37800

Case Details

VAERS ID: 37800 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-08-27
Onset:1991-09-03
   Days after vaccination:7
Submitted: 1991-11-26
   Days after onset:84
Entered: 1991-12-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Confusional state, Convulsion, Headache, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC Split Type: IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


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