National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 416930

Government Disclaimer on use of this data



Case Details

VAERS ID: 416930 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Male  
Location: Delaware  
Vaccinated:2010-11-02
Onset:2010-11-25
   Days after vaccination:23
Submitted: 2011-02-16
   Days after onset:83
Entered: 2011-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3486AA / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Cardioversion, Convulsion, Death, Hypoxic-ischaemic encephalopathy
SMQs:, Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: seizure resulting in defribrilation resulting in anoxic brain injury. treated at Hospital.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=416930


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166