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This is VAERS ID 50793

Case Details

VAERS ID: 50793 (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: 1993-03-07
   Days after onset:551
Entered: 1993-03-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Coma, Convulsion, Encephalitis, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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:
Current Illness:
Preexisting Conditions: poss of asthma (allergy to cats)
Allergies:
Diagnostic Lab Data: autopsy report concluded that pt died of post vaccinal encephalitis;
CDC Split Type:

Write-up: severe h/a 3SEP91 AM-PM; vomiting p/MN; seizures 7AM on 4SEP91; coma-death 1225PM on 4SEP91;


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