Age: 1.25
Sex: M
Vaccine: MMR
Symptoms: Blood alkaline phosphatase increased, Coma, Febrile convulsion, Grunting, Haemoglobin decreased
Clinical narrative: Information has been received from a physician concerning a 15 month old white male with no family history of seizures, no exposure to toxic chemicals, no history of head trauma who was vaccinated with a dose of MMRII. In the follow-up, the physicuan's office reported that they could not provide a lot number, since  "it was not mandatory for the lot numbers to be documented" in 1983. There were no concomitant  medications o illness at the time of vaccination. Originally, the physician reported that the pt was vaccinated on 5/11/83, however in follow-up, the physician reported that the vaccine was administered on 4/11/83. In follow-up, the physician reported that the pt was well until 24 hours prior to admission to the hospital on 4/17/83. On 4/16/83, the pt developed a fever of approx. 101 F, which he was treated with aspirin and Tylenol with resolution of the fever. On the PM of 4/17/83, the pt's temperature again increased to approx. 101F. At approx. 04:00, on 4/17/83, the pt's parents heard unusual respiratory noises, they found the child with his eyes open, staring, making grunting respiratory sounds, they could not rouse him. The child was brought by EMS to the hospital. Upon arrival to the ER, the pt was more responsive and alert. The pt's temperature was 101.8F. Physical exam revealed a well nourished male in no distress. The pt's vital signs were stable. The pt was normocephalic, there was pigmented nevus on the scalp. The pt's pupils were equal, round, responsive to light and accommodation. Tympanic membranes were normal. Lymphatics were normal. The pt's neck was supple and there was no significant lymphadenopathy. The pt's chest was symmetrical. Lungs were clear. The pt's heart was regular with a normal sinus rhythm, with no murmurs. The pt's abdomen was soft, non-tender, no organomegaly, no masses. Genitalia was noted as normal, immature male. Extremities were within normal limits. The pt's skin was clear. On neurological exam, the pt was alert, cooperative, no focal deficits, no seizure activity, no tremor, or ataxia. On admission, the pt's chest x-ray was within normal limits. The pt'scomplete blood count (CBC) reveaqled hemoglobin of 9.8 and slighty decreased mean corpuscular volume (MCV). The pt's chemistry panels (SMA 6 AND SMA 12) were within normal limits., with the exception of alkaline phosphates which was over 3,500 which was repeated on separate specimen and confirmed. The pt was dx'd with febrile seizure, questionably secondary to MMR vaccine and elevated alkaline phosphatase, etiology unknown. The pt had no elevation over 101F in 36 hours of hospitalization and was discharged. The pt took phenobarbital for 1 year, post seizure. The pt had 1 more seizure after his initial episode. Previously, the physician reported that the pt had a seizure, was found flaccid on 5/11/83 (which he reported to be one month prior to the episode above). The pt was afebrile. Upon internal review, seizure was determined to be an "Other Important Medical Event". Additional information has been requested. This is an amended report. The responsible physician information has changed and the advers event onset date was changed from 4/17/1983 to 4/16/83. This report is corrected as amended. Follow-up information from medical records indicated that the pt was vaccinated on 05/11/1983, not 04/11/1983 as previously reported, with a dose of MMR. On 05/17/1983 the pt was admitted to the hospital for a seizure and ran a temp of 101.8 deg. F. On 05/10/1983, the pt was discharged from the hospital with a probable seizure and temperature. No treatment was given and the pt did well. His CMA-2 revealed an alk phos >3500 and this was repeated x 1 with the same result. The pt has no evidence of bone or liver disease. The physician's assessment was normal 15 month old. The plan was to repeat an alk phos and calcium/potassium in a week. On 06/10/1983, the pt was seen for congestion and slight cough and was diagnosed with a URI. It was reported that the pt's cousin had Wilson's Disease. NO Kayser Fleischer ring was noted in the pt. On 06/22/1983, the pt experienced another febrile seizure. He was prescribed Pediazole and phenobarbital. Lab tests were performed and were as follows: Ca 10.2; P-5.3; alk phos <80; SGPT-12; SGOT-53; ceruloplasmin 35 (N 18-57). The pt was scheduled for an EEg. On 06/29/1983 it was reported that the pt was doing well. On 07/20/1983, the pt was switched to phenobarbital. It was reported that subsequently the pt recovered. The pt's URI was considered to be incidental findings. No further information is expected.