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Overview. Reporting and recording of an AEFI case. This case history is hypothetical. Hypothetical Case Study. Adverse Event Following Immunization. ANM. AWW. OK! Thanks for reporting.
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Overview Reporting and recording of an AEFI case. This case history is hypothetical.
Hypothetical Case Study Adverse Event Following Immunization
ANM AWW OK! Thanks for reporting ……… regarding an AEFI case in village Siyapur where I had conducted immunization session today …… Child is reported to be serious………… Santoshi!!!!! Guddi D/O Lakhan Pal is not well after immunization ….. OK! Thanks for reporting
1 Case Study (District: Barwani (BRW), Madhya Pradesh (MP) Conversation between ANM of Ramgarh PHC, block Gopalganj and Medical Officer Incharge Dr. Nagesh Kumar of this block) • ANM: Sir, my name is Santosh Kumari and I work in sub centre Lubana • MOIc: Yes! Ms. Santosh, what makes you call at this hour. It is already 9:00 PM • ANM:The news is not good. The AWW of the village just called to inform regarding an AEFI case in village Siyapur where I had conducted immunization session today (dt 28/06/07). Child is reported to be serious. • MOIc:Do not panic, please let me know the details of the reported case • ANM:The name of the child is Guddi, Age-10 months, D/O – Lakhan Pal Kewat, Village-Siyapur, Near- Shiv Mandir • MOIc:When & What vaccines were administered to the child?
2 Case Study • ANM:At 11:30 am, measles Vaccine and Vitamin-A 1st dose • MOIc: Do you have the details of vaccine, diluents & vitamin-A administered! • ANM: I noted the batch number and expiry dates of measles vaccine and vitamin-A. Measles: Batch. No-MV317, Mf. Date: Feb 07, Ex. Date: Jan 09 & Vit-A was within normal manufacturing and expiry limit. I used the diluent but did not record any details • MOIc: Are you sure you used the right diluent? • ANM: Yes ! Distilled Water Ampoule that was provided in the vaccine carrier from the PHC today • MOIc: Good! let us plan to reach Siyapur as soon as possible. I am starting right away but will not be able to reach there before 5:00am as there is no way to cross the river at this time
3 Case Study On reaching the Village(MOIc Dr. Nagesh reached the village at 6:00 am. ANM Santosh Kumari reached the village at 6:15 am) Conversation with parents/attendants/ANM • MOIc:Namaskar! How is Guddi? • Father (Mr. Lakhan Pal):Guddi has been suffering from high fever, vomiting and frequent seizures. She was vaccinated yesterday in Govt. Primary School and developed these symptoms 7 hours after vaccination. • MOIc(after examining the child):I have started the I / V drip and given the basic symptomatic treatment but to further manage we will have to shift Guddi to the district hospital immediately. Santosh Kumari will help you to shift the child to District Hospital. • ANM:Sir, at the moment the only means of available transport is the Tempo and I have asked the driver to reach here immediately. • MOIc:Don’t worry, Lakhan Pal. We will do the best we can to help Guddi. I will see you in District Hospital. Before reaching the hospital the child died. They reached district hospital at 4:00 PM
First Information Report (FIR)(within 48 hrs to the GoI) The medical officer Dr. Nagesh Kumar filled the FIR and submitted to DIO Dr. Ravinder Jain of the district. As this case belongs to the category of *serious AEFIs so as per Guidelines the DIO sent a copy of FIR to Assistant Commissioner (UIP), Govt. of India and State Headquarters On getting this information and FIR from the medical officer Dr. Ravinder Jain went to the district hospital and investigated the events in presence of Dr. Nagesh Kumar (MOIc), Santosh Kumar (ANM) and pediatrician on emergency duty Dr. Rama Singh What more could be enquired on first visit? *Serious: Death / Hospitalized
4 Case Study(District AEFI Committee Meeting) • 30th June: DIO Ravinder Jain calls a meeting of the District Level AEFI Committee • The members of this committee include • DIO (Dr. Ravinder Jain) • Pediatrician (Dr. Rama Singh) • Micro biologist (Dr. Asha Goel) • Physician (Dr. Ashutosh Kapoor) • The committee decides to visit the village on 3rd July • DIO informs MOIc Dr. Nagesh and ANM Santosh Kumari and LHV (Supervisor) to be available on 3rd July to visit village Siyapur with the team for preliminary investigation
5 Case Study On 3rd Jul 07 • DIO visits village Siyapur with the district and the block team( MOIc, ANM & health supervisor). They console the family and gather details (past and present medical history of the deceased child) . • Dr Rama Singh briefs the team that the family had refused to get the postmortem done • On enquiry the mother disclosed that 2 months back the deceased had once fallen from her lap and 2 days later she was suffering with fever. 4th day after the fall child had frequent seizures and vomiting and was under treatment from a village quack and RMP. This information was not shared with the MO or ANM. • The family provided the team with all available previous medical records The DIO filled the PIR and submitted to AC (UIP), GoI with a copy to the State Headquarter (SEPIO)
How is PIR different from FIR • FIR is submitted within 48 hrs • PIR is submitted within 7 days with the following additional information • Probable cause of Death? • Probable cause of the AE? • Further action planned?
How is DIR different from FIR& PIR • FIR is submitted within 48 hrs (2 days) • PIR is submitted within 7 days • DIR is submitted within 90 days (3 mths) with following additional information • No. of children immunized at the session • Type of syringes used • Type of AEFI • If patient admitted to the hospital then Name of the hospital, Ward No., Centralized admission number & outcome • Symptoms & signs • Treatment given • Family History etc.
