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This is VAERS ID 414511

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2011

VAERS ID: 414511
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 4/13/2011

VAERS ID: 414511 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Aphasia, Blood albumin decreased, Blood calcium decreased, Blood chloride decreased, Blood gases abnormal, Blood sodium decreased, Carbon dioxide decreased, Cerebellar ataxia, Cerebellar syndrome, Cogwheel rigidity, Coma, Confusional state, Death, Disorientation, Dysuria, Encephalopathy, Gait disturbance, Headache, Hypertonia, Intensive care, Lumbar puncture, Nuclear magnetic resonance imaging, Posture abnormal, Protein total decreased, Pyrexia, Rash papular, Rhinorrhoea, Subacute sclerosing panencephalitis, Tachycardia, Vomiting, Mental status changes, Blood phosphorus decreased, Blood bilirubin decreased, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 5/13/2011

VAERS ID: 414511 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Aphasia, Blood albumin decreased, Blood calcium decreased, Blood chloride decreased, Blood gases abnormal, Blood sodium decreased, Carbon dioxide decreased, Cerebellar ataxia, Cerebellar syndrome, Cogwheel rigidity, Coma, Confusional state, Death, Disorientation, Dysuria, Encephalopathy, Gait disturbance, Headache, Hypertonia, Intensive care, Lumbar puncture, Nuclear magnetic resonance imaging, Posture abnormal, Protein total decreased, Pyrexia, Rash papular, Rhinorrhoea, Subacute sclerosing panencephalitis, Tachycardia, Vomiting, Mental status changes, Blood phosphorus decreased, Blood bilirubin decreased, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 7/12/2011

VAERS ID: 414511 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 7/7/2013

VAERS ID: 414511 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 6/14/2014

VAERS ID: 414511 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 2/14/2017

VAERS ID: 414511 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / - - / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 9/14/2017

VAERS ID: 414511 Before After
VAERS Form:(blank) 1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / - UNK - NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 2/14/2018

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 6/14/2018

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 8/14/2018

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 9/14/2018

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 10/14/2018

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 12/24/2020

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 12/30/2020

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 5/7/2021

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


Changed on 5/21/2021

VAERS ID: 414511 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:2010-11-08
Onset:2010-12-19
Submitted:2011-01-11
Entered:2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-02
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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC 'Split Type':

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.

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