1. Hypothetical Case Overview Reporting and recording of an AEFI case. This case history is hypothetical.

2. Hypothetical Case Hypothetical Case Study Adverse Event Following Immunization

3. Hypothetical Case ……… 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 AWW ANM

4. Hypothetical Case (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? Case Study 1

5. Hypothetical Case Case Study ANM: At 11:30 am, measles Vaccine and Vitamin-A 1 st 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 2

6. Hypothetical Case 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 3

7. Hypothetical Case 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

8. Hypothetical Case Case Study (District AEFI Committee Meeting) 30 th 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 3 rd July DIO informs MOIc Dr. Nagesh and ANM Santosh Kumari and LHV (Supervisor) to be available on 3 rd July to visit village Siyapur with the team for preliminary investigation 4

9. Hypothetical Case Case Study On 3 rd 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. 4 th 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) 5

10. Hypothetical Case 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?

11. Hypothetical Case 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.

12. Hypothetical Case Solution…..

13. Hypothetical Case FIR: Format State: MPDistrict: Barwani Block: GopalganjDate of report: 29/06/07 Name: Guddi Age(DOB): 10 monthsSex: Female Mother’s / Father’s Name: Mr. Lakhan Pal Kewat Complete Address of the case: Village- Siyapur, Near- Shiv Mandir Date & time of vaccination: 28/06/07Date & time of onset of symptoms: 28/06/07 Complete address of place of vaccination: Primary School, Siyapur, Gopalganj, Barwani Vaccine given: Measles, 1 st dose of Vitamin-A Batch number & expiry date of each vaccine : Measles - Batch. No- MV317, Mf. Date: Feb 07, Ex. Date: Jan 09; Vitamin-A: Not known Type of reaction: high fever, vomiting and frequent seizures Date of Death: 29/06/07 Any other comment:

14. Hypothetical Case PIR: Format State: MPDistrict: Barwani Block: GopalganjDate of report: 29/06/07 Name: Guddi Age(DOB): 10 monthsSex: Female Mother’s / Father’s Name: Mr. Lakhan Pal Kewat Complete Address of the case: Village- Siyapur, Near- Shiv Mandir Date & time of vaccination: 28/06/07Date & time of onset of symptoms: 28/06/07 Complete address of place of vaccination: Primary School, Siyapur, Gopalganj, Barwani Vaccine given: Measles, 1 st dose of Vitamin-A Batch number & expiry date of each vaccine : Measles - Batch. No-MV317, Mf. Date: Feb 07, Ex. Date: Jan 09; Vitamin-A: Not known Type of reaction: high fever, vomiting and frequent seizures Date of Death: 29/06/07 Probable Cause of death: Probable Cause of AE: Further action planned: Any other comment: