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This is VAERS ID 407037

History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 407037
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 1/4/2011

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 4/13/2011

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Acute respiratory failure, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Blood creatine phosphokinase MB increased, Blood gases abnormal, Blood glucose increased, Blood potassium increased, Blood pressure decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Chest X-ray normal, Condition aggravated, Convulsion, Death, Dysphagia, Dyspnoea, Electrocardiogram abnormal, Haematocrit decreased, Haemoglobin decreased, Hypoxia, Influenza, Intensive care, Livedo reticularis, Lobar pneumonia, Nasal congestion, Neutrophil count increased, Pneumonitis, Pyrexia, Red blood cell count decreased, Rhinorrhoea, Septic shock, Sinus tachycardia, White blood cell count increased, White blood cells urine positive, Urinary sediment present, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Protein urine present, Brain natriuretic peptide increased, Troponin I increased, Mechanical ventilation, Endotracheal intubation, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 5/13/2011

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Acute respiratory failure, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Blood creatine phosphokinase MB increased, Blood gases abnormal, Blood glucose increased, Blood potassium increased, Blood pressure decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Chest X-ray normal, Condition aggravated, Convulsion, Death, Dysphagia, Dyspnoea, Electrocardiogram abnormal, Haematocrit decreased, Haemoglobin decreased, Hypoxia, Influenza, Intensive care, Livedo reticularis, Lobar pneumonia, Nasal congestion, Neutrophil count increased, Pneumonitis, Pyrexia, Red blood cell count decreased, Rhinorrhoea, Septic shock, Sinus tachycardia, White blood cell count increased, White blood cells urine positive, Urinary sediment present, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Protein urine present, Brain natriuretic peptide increased, Troponin I increased, Mechanical ventilation, Endotracheal intubation, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 7/12/2011

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 4 LA / IM
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 7/7/2013

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 4 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 6/14/2014

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 3/14/2015

VAERS ID: 407037 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 4 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 9/14/2017

VAERS ID: 407037 Before After
VAERS Form:(blank) 1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 4 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 2/14/2018

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 6/14/2018

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 8/14/2018

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 9/14/2018

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 10/14/2018

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 12/24/2020

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 12/30/2020

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 5/7/2021

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


Changed on 5/14/2021

VAERS ID: 407037 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Michigan
Vaccinated:2010-10-08
Onset:2010-10-11
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC 'Split Type':

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.

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