Historian: Charles Jebb B. JuanitasDate & time of Interview: July 29, 2015; 1:00PM

I. General Data

Informant: Carolina Donque (maternal grandmother of the patient)Patients name: Jyle Christoph DonqueNationality: FilipinoDate of birth: November 29, 2013(1 year, 8 months, 0 days)Address: Quintin Salas, Jaro, Iloilo CityNo. of Admissions: 1Sex: MaleBirthplace:Mandurriao, Iloilo City

II. Chief complaint:

nag convulsion kag hilanat (upward rolling of eyeballs)

III. History of present illness

4-5 days PTA, the patient had cough but was reported to be alert, not showing signs of weakness. His cough was described as ga sagrak with phlegm that cannot be expressed by the patient. The color of the phlegm was not identified. 3 hours PTA, the patient was reported to be feverish by his grandfather. The informant was not present. The patient was still having coughs at this time.2 hours PTA, the patient started having convulsions lasting no longer than 2 minutes and was seemingly not breathing. He was wiped down with a damp cloth and was taken to WVSU Medical Center. He was reported to be breathing upon admission. His temperature was recorded as 42C. Thus this admission.

IV. Past personal history

a. PrenatalThe patients mother started prenatal checkups at the health center in Quintin Salas at 4 months AOG as reported by the informant. She took ferrous sulfate, multivitamins and folic acid supplements during her pregnancy. She had episodes of cough and nasal catarrh and sought treatment but no medications were recalled by the informant.No alcoholic beverages were consumed during the pregnancy as reported by the informant. There was also no radiation exposure as claimed.

b. NatalThe mothers OB score at birth of the patient is G1P1 (1001). She was 23 years old at the time of the patients birth. The patient was delivered at Western Visayas Medical Center in Mandurriao by normal spontaneous vaginal delivery after 6-7 hours of labor as reported. He was full term with a birth weight reported at 3 kg. His length was claimed by the informant as taas.

JCD was given BCG, hepatitis B vaccine and vitamin K shortly after birth. No APGAR score was given by the informant but the baby was reported to be vigorously crying. No jaundice, head trauma, seizures, infections or other complications were reported.

c. NeonatalJCD patient was reported to pass meconium and urinate within 24 hours after birth. He undergone Newborn Screening after birth and no significant results were reported. His blood type was tested though unrecalled by the informant.

d. FeedingJCD was breastfed for three weeks after birth. The mothers necessity to go back to work was pointed out by CD as a factor for discontinuing exclusive breastfeeding. He was given Formula milk (Nestogen) after the breastfeeding period.Complementary food was given at 5 months of age. He was fed with soup, vegetables and su-am, and occasionally was given chocolates by his mother.

e. Developmental/behavioral history

The following milestones were achieved at ages reported by the informant:

Gross MotorHead control 2 monthsProne 3 monthsSat alone 3 monthsStand with support 6 monthsWalked Alone 9 monthsRan 20 monthsFine MotorFixated newbornReached 5 monthsHeld bottle 7 monthsScribbled 20 monthsPersonal/SocialSmiled responsively -