|
VAERS ID: |
25003 (history) |
Form: |
Version 1.0 |
Age: |
0.8 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: |
1990-01-29 |
Onset: |
1990-02-04 |
Days after vaccination: |
6 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Delirium, Hypokinesia, Hypotonia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
|
VAERS ID: |
25026 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: |
1990-01-12 |
Onset: |
1990-01-14 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
229974 / UNK |
- / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
9A11092 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
244970 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-01-14
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio |
|
VAERS ID: |
25028 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: |
1989-05-24 |
Onset: |
1990-06-24 |
Days after vaccination: |
396 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8L01022 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Meningitis SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-06-25
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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt admitted with H-Flu meningitis on 24Jun90. Pt expired on 25Jun90. Pt received HIB vaccine at 18 months of age. |
|
VAERS ID: |
25526 (history) |
Form: |
Version 1.0 |
Age: |
45.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
1990-06-08 |
Onset: |
1990-06-17 |
Days after vaccination: |
9 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Abdominal pain, Acidosis, Anaphylactoid reaction, Cardiac arrest, Cardiac failure, Haematemesis, Injection site pain, Pancreatitis, Pyrexia, Renal failure SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-06-19
Days after onset: 2 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: Allergies: Diagnostic Lab Data: 30Jul90- cause of death: anaphylactic shock; the poisonous efectof ingested food stuff causing an accute systemic anaphylactic response which led to acute myocardial failure & ended in cardo-respiratory arrest. CDC Split Type: CO3526 Write-up: Pt given Imovax rabies on 9-JUN-90 c/o sore arm. 17-JUN-90 pt. had fever & abd tenderness. Family member states worsened. While traveling w/husband pt. began to vomit blood. Taken to ER & admittedto intensive care. Pt had a cardiac arrest |
|
VAERS ID: |
25530 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Indiana |
Vaccinated: |
1990-06-04 |
Onset: |
1990-06-04 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
262913 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Agitation, Pyrexia, Sudden infant death syndrome SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-06-05
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: no relevant hx, no siblings Allergies: Diagnostic Lab Data: CDC Split Type: 9001011.01 Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS |
|
VAERS ID: |
25534 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: |
1987-12-09 |
Onset: |
1990-06-25 |
Days after vaccination: |
929 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH |
181666 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Drug ineffective, Infection SMQs:, Lack of efficacy/effect (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-06-25
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001160.01 Write-up: 4 1/2 yr old child 25Jun90/w positive blood culture for h. Influenzae type B. Child received immunization on 9Dec87 |
|
VAERS ID: |
25535 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: |
1990-03-28 |
Onset: |
1990-03-28 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271962 / 2 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
259949 / 2 |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-03-28
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Autopsy revealed no pathology in any organ system that could explain the death of this infant, therefore, this is a case of sudden death syndrome. CDC Split Type: 9000592.01 Write-up: normal 4 moth old infant received DTP/OPV in office at on 28Mar90, put to bed at 10:00pm; found dead at 10:30 pm. |
|
VAERS ID: |
25543 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Unknown |
Location: |
Wisconsin |
Vaccinated: |
0000-00-00 |
Onset: |
0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Diarrhoea, Respiratory disorder SMQs:, Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001123.01 Write-up: 4 month old infant received first DTP/OPV immun. & had no immediate problems, was apparently well & healthy. 9-10 days later, developed repiratory symptoms & diarrhea, then found dead the following day. |
|
VAERS ID: |
25553 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: |
1990-06-25 |
Onset: |
1990-06-27 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9J01114 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: none Current Illness: routine well baby checkup given Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM. |
|
VAERS ID: |
25556 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
New York |
Vaccinated: |
1989-10-20 |
Onset: |
1989-10-25 |
Days after vaccination: |
5 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
42622/1644R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sepsis SMQs:, Sepsis (narrow), Opportunistic infections (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-10-25
Days after onset: 0 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: no relevant history Preexisting Conditions: Allergies: Diagnostic Lab Data: autopsy-strep sepsis, The physician & autopsy pathologist felt that the pt''s dealth was not related to vaccination. CDC Split Type: WAES89100782 Write-up: MD reported pt initially vac. w/ MMR live at 15 mo''s was vac. w/ booster MMR on 10-20-89 along w/ DTP. Pt died 10-25-89. Autopsy = overwhelming strep. sepsis. MD and autopsy pathologist felt pt death not related to vaccination. |
|
VAERS ID: |
25569 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: |
1987-11-10 |
Onset: |
1987-12-29 |
Days after vaccination: |
49 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MU: MUMPS (MUMPSVAX I) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Chest pain, Electrocardiogram abnormal, Myocarditis SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Extended hospital stay? Yes Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no relevant history Allergies: Diagnostic Lab Data: Autopsy revealed a grossly normal pancreas. Additional info. requested. CDC Split Type: WAES90060971 Write-up: Pt vacc. /w Mumpsvax 1st dose in response to local mumps epidemic, 2 wks later he developed chest pain & abnormal ECG. Admitt to hospital & died 2 days later /p admission /w DX of myocarditis.MD could not establish a causal relationship. |
|
VAERS ID: |
25581 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: |
1990-01-25 |
Onset: |
0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
585A4 / 2 |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Drug ineffective, Encephalitis, Infection SMQs:, Lack of efficacy/effect (narrow), Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-05-19 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: no known allergies, non responder to previous 3 dose /w MSD vaccine Allergies: Diagnostic Lab Data: 10Jan90 titer test = non responsive, Herpes varicella recovered from brain CDC Split Type: EBU900170 Write-up: Pt given a series of 3 MSD Hep-B vaccines, & 2 Engerix-B vaccines due to being non responder. Pt developed encephalitis & died. Herpes varicella recovered form brain |
|
VAERS ID: |
25683 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: |
1990-06-29 |
Onset: |
1990-07-02 |
Days after vaccination: |
3 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271911 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0603F / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-07-02
Days after onset: 0 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: hx of infantile apnea syndrome Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor. |
|
VAERS ID: |
25703 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: |
1990-06-26 |
Onset: |
1990-06-26 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
235944 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-06-26
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS |
|
VAERS ID: |
25780 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: |
1990-07-26 |
Onset: |
1990-07-28 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings. Allergies: Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested CDC Split Type: 9001336.01 Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival. |
|
VAERS ID: |
25799 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
1988-09-28 |
Onset: |
1988-10-01 |
Days after vaccination: |
3 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Brain oedema, Cerebral haemorrhage, Coagulopathy, Convulsion, Meningitis, Respiratory disorder, Sepsis SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: hx of croup once in 08/87; Congenital hip dysplasia Allergies: Diagnostic Lab Data: CDC Split Type: CO3592 Write-up: Haemophilus influenzae, type B meningitis & sepsis. Complications; seizures, cerebral edema, intracerebral bleed, DIC & ARDS. |
|
VAERS ID: |
25870 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1990-08-24 |
Onset: |
1990-08-25 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
279947 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
61706 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Agitation, Pyrexia, Stupor SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV became irritable, body temp 100.f. No vomiting or other symptoms; Fell asleep at 6AM when parents went to wake him for feeding noted to be unresponsive. Paramedics were called brought to ER. |
|
VAERS ID: |
25912 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Alaska |
Vaccinated: |
1990-06-08 |
Onset: |
1990-06-08 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B11061 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0605H / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia, Screaming, Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, ? days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: elevated temperature of 103+, projectile vomitting, continued high pitched crying. Medical examination by treating physician & released. |
|
VAERS ID: |
25913 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: |
1990-01-24 |
Onset: |
1990-01-25 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256960 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema SMQs:, Cardiac failure (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-01-25
Days after onset: 0 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: Allergies: Diagnostic Lab Data: See WORM for autopsy report, emergency room reports CDC Split Type: Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child. |
|
VAERS ID: |
25975 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: |
1990-08-27 |
Onset: |
0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0L11101 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
617M / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV no acute rx reported by mother 48 hrs post immunization |
|
VAERS ID: |
25989 (history) |
Form: |
Version 1.0 |
Age: |
1.8 |
Sex: |
Female |
Location: |
Hawaii |
Vaccinated: |
1989-09-12 |
Onset: |
1989-09-12 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9G101042 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
595 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Abdominal distension, Agitation, Atelectasis, Dyspnoea, Gastric dilatation SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-09-13
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: Premature infant w/numerous medical problems. Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV developed cardiorespiratory arrest less than 24 hrs after vax. Pt noted to have abd distension and fussiness along with some respiratory distress prior to arrest. Pt was premature infant w/several med problems. |
|
VAERS ID: |
25994 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Wyoming |
Vaccinated: |
1989-12-05 |
Onset: |
1989-12-29 |
Days after vaccination: |
24 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / 4 |
- / L |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2068P / 1 |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
298B1 / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Asphyxia, Brain oedema, Immune system disorder, Infection, Necrosis, Pulmonary haemorrhage, Pulmonary oedema, Splenomegaly SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Pedizole, Tassi Organdin Current Illness: Otitis, Bronchitis Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy was contradictory /w no conclusions & many signs of Pertussis reactions. CDC Split Type: Write-up: Casey was given DPT/MMR/OPV while still on anitbiotic Pedizole and tassii organdin for otitis & bronchitis. He appeared happy & well until he died in his sleep. Shots were given on 5DEC89. |
|
VAERS ID: |
26080 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: |
1990-05-18 |
Onset: |
1990-05-19 |
Days after vaccination: |
1 |
Submitted: |
1990-09-18 |
Days after onset: |
122 |
Entered: |
1990-09-24 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB |
DTP270 / 1 |
LL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
268953 / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-05-19
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Hydorcortisone for rash Current Illness: Preexisting Conditions: Heart M gr I/VI (Non significant) Premature (36-37 wks) Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV found to have funny breathing early AM later mother found her not breathing. |
|
VAERS ID: |
26112 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: |
1990-09-11 |
Onset: |
1990-09-13 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-09-13
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Child immunized with DTP/OPV vaccines on 11SEP90. Sudden Infant Death Syndrome. |
|
VAERS ID: |
26159 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: |
1990-09-20 |
Onset: |
1990-09-20 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-09-20
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Methyprednisolone, Verapamil, Proventil, Albuterol, Anhydrous Theophylline Current Illness: Severe Bronchial Asthma Preexisting Conditions: Pt was hospitalized 2-3 yrs ago for hypertensive Crisis & Severe Bronchial Asthma. Allergies: Diagnostic Lab Data: HGT=5''6"; WGT=99lbs; Morning of 20SEP90 BP=142/86;P=72/min®. CDC Split Type: 904090001 Write-up: Pt vaccinated with FLUOGEN who has severe bronchial asthma seen in MD ofc well VS stable & chest clear, death & respiratory arrest. |
|
VAERS ID: |
26175 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: |
1990-09-05 |
Onset: |
1990-09-11 |
Days after vaccination: |
6 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-03 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
0F11072 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP 5SEP90 developed SIDS. |
|
VAERS ID: |
26196 (history) |
Form: |
Version 1.0 |
Age: |
0.51 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: |
1990-08-20 |
Onset: |
1990-08-22 |
Days after vaccination: |
2 |
Submitted: |
1990-10-02 |
Days after onset: |
41 |
Entered: |
1990-10-10 |
Days after submission: |
8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
1211A / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0611E / 2 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-08-22
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: None w/exception of Regurgitation Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr. CDC Split Type: Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee. |
|
VAERS ID: |
26209 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Unknown |
Location: |
North Carolina |
Vaccinated: |
1990-09-11 |
Onset: |
1990-09-11 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
268910 / 2 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0608E / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-09-13
Days after onset: 2 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: Allergies: Diagnostic Lab Data: Autopsy pending - copy of report requested CDC Split Type: 9001603.01 Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration. |
|
VAERS ID: |
26224 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: |
1990-07-31 |
Onset: |
1990-08-05 |
Days after vaccination: |
5 |
Submitted: |
1990-10-06 |
Days after onset: |
62 |
Entered: |
1990-10-12 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH |
- / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / SC |
Administered by: Private Purchased by: Private Symptoms: Face oedema, Hypersensitivity, Oedema, Sudden infant death syndrome SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-08-11
Days after onset: 6 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 2 days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Hypoglycemic of Newborn; R/O Sepc as newborn Allergies: Diagnostic Lab Data: Chest X-Ray Neg; All lab work neg; SGOT = 200; NA 123; EKG neg; ECHO heart neg CDC Split Type: Write-up: Pt vaccinated with MMR/HIB developed puffy eyes seen in office dx allergy given Benadryl; Seen 8AUG some vomiting, 9AUG admitted more puffiness & edematous See WORM for more details. |
|
VAERS ID: |
26229 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: |
1990-09-06 |
Onset: |
1990-09-07 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9B11033 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-09-07
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Acetaminophen Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Blood cultures at time of death grew E. Coli, TEXT: death resulted CDC Split Type: Write-up: Pt vacc. /w DTP 24 hrs later child died. Child had URI, /p shot fever, she fed normally 8 hrs before death. In AM mother went to dress child, child blinked, gasped & then arrested. F/U DR called 30Oct90 lab data not consistant /w moms hx |
|
VAERS ID: |
26236 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: |
1989-10-03 |
Onset: |
1990-01-01 |
Days after vaccination: |
90 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
CP284 / 4 |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Hepatic failure, Pulmonary oedema, Sepsis SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-01-29
Days after onset: 28 Permanent Disability? Yes Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Extended hospital stay? Yes Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: CVA; Seizure disorder; Diabetes mellitus; End stage renal disease; Hypertension; Ischemic heart disease Allergies: Diagnostic Lab Data: No relevant data. CDC Split Type: WAES90011108 Write-up: Pt w/diabetes mellitus vaccinated w/Recombivax HB entered a study comparing safey & efficacy of hepatitis B (Pre S2+S) vaccine Reocmb & Hepatitis B Vac Recomb in dialysis pt. Was hospitalized because pulmonary edema then sepsis & liver fail |
|
VAERS ID: |
26239 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Unknown |
Location: |
New Hampshire |
Vaccinated: |
1989-07-27 |
Onset: |
0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
244984 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
250939 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion, Hypertonia, Hypotonia, Insomnia, Screaming, Vomiting SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Extended hospital stay? Yes Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 9001575.01 Write-up: Pt vaccinated with DTP/OPV had loss of head control, screaming & vomiting, sleep loss; limbs tense also developed seizures. Hospitalized multiple times between 9-12/89. Received DT, condiiton worsened; died 18ARP90. |
|
VAERS ID: |
26241 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: |
1989-06-20 |
Onset: |
1989-06-23 |
Days after vaccination: |
3 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
232968 / 4 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: CSF test abnormal, Cerebrovascular disorder, Convulsion, Delirium, Encephalopathy, Hepatic necrosis, Neuropathy, Pneumonia SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Immune-mediated/autoimmune disorders (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-03-28
Days after onset: 278 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 60 days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 9001578.01 Write-up: Pt vaccinated with DTP then death occurred 3/90. Cause of death listed as reaction to DTP vaccination. |
|
VAERS ID: |
26250 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Unknown |
Location: |
California |
Vaccinated: |
1990-08-29 |
Onset: |
1990-08-31 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283913 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
265925 / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Apnoea, Cyanosis, Hypokinesia, Sudden infant death syndrome SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-08-31
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Autopsey - SFC&C coroner CDC Split Type: Write-up: Pt vaccinated with DTP/OPV found shortly after being put down for nap unresponsibe, apnea, blue & resuscitation unsuccessful. Verbal autopsey Dr SIDS. |
|
VAERS ID: |
26282 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Nevada |
Vaccinated: |
1989-12-01 |
Onset: |
1989-12-03 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
5794F / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-12-03
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001626.01 Write-up: CDC Reports that 3 mo old infant received 1st DTP/OPV on 1DEC89 & died 3DEC89. |
|
VAERS ID: |
26283 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: |
1989-08-23 |
Onset: |
1989-08-25 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
226947 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-08-25
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001627.01 Write-up: CDC Reports that 3 mo infant received DTP/OPV on 23AUG89 and died 25AUG89. |
|
VAERS ID: |
26284 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: |
1990-02-27 |
Onset: |
1990-03-03 |
Days after vaccination: |
4 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256962 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
256927 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-03-03
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001628.01 Write-up: CDC Reports: 2 mo infant received DTP/OPV on 27FEB90 and died 3MAR90. |
|
VAERS ID: |
26285 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: |
1990-03-19 |
Onset: |
1990-03-20 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256962 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0599C / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-03-20
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001628.02 Write-up: CDC Reports: 5 mo infant received DTP/OPV on 19MAR90 and died 20AMR90. Patient was given Tylenol for a low grade fever 3 hrs before death. |
|
VAERS ID: |
26286 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
New Hampshire |
Vaccinated: |
1989-10-12 |
Onset: |
1989-11-08 |
Days after vaccination: |
27 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0589H / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-11-08
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001629.01 Write-up: CDC Reports: 2 mo infant received DTP/OPV on 12OCT89 and died 8NOV89. |
|
VAERS ID: |
26287 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
New Hampshire |
Vaccinated: |
1989-12-15 |
Onset: |
1989-12-15 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0589H / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-12-15
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001629.02 Write-up: CDC Reports: 2 mo infant received DTP/OPV on 11DEC89 and died 15DEC89. |
|
VAERS ID: |
26288 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
New Hampshire |
Vaccinated: |
1989-11-21 |
Onset: |
1989-11-21 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0599C / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-11-21
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001629.03 Write-up: CDC Reports: 2 mo infant received DTP/OPV on 8NOV89 and 21NOV89. |
|
VAERS ID: |
26289 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
New Hampshire |
Vaccinated: |
1989-10-11 |
Onset: |
1989-10-13 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
247439 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-10-13
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Known balanced translocation, chromosome 245 cause of death unknown, post WNL, Tox pending. CDC Split Type: 9001629.04 Write-up: CDC reports: 3 mo infant received DTP/OPV on 11OCT89 and died 13OCT89. |
|
VAERS ID: |
26290 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Louisiana |
Vaccinated: |
1990-01-25 |
Onset: |
1990-02-03 |
Days after vaccination: |
9 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256965 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0592B / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-02-03
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001630.01 Write-up: CDC reports: 5 mo infant received DTP/OPV on 25JAN90 and died 3FEB90. |
|
VAERS ID: |
26291 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: |
1989-11-08 |
Onset: |
1989-11-08 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
253980 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
256928 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-11-08
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Autopsy performed CDC Split Type: 9001631.01 Write-up: CDC reports 4 mo infant received DTP/OPV on 8NOV89 and died 4 hrs later. |
|
VAERS ID: |
26292 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: |
1989-10-31 |
Onset: |
1989-11-07 |
Days after vaccination: |
7 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
253980 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
250939 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-11-07
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Gross post mortem negative; Autopsy performed. CDC Split Type: 9001631.02 Write-up: CDC Reports: 3 mo infant received DTP/OPV on 31OCT89 and died 7NOV89. |
|
VAERS ID: |
26293 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: |
1989-09-27 |
Onset: |
1989-09-29 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256959 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0594F / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-09-29
Days after onset: 0 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: Allergies: Diagnostic Lab Data: No Autopsy. SIDS on death certificate, also natural CDC Split Type: 9001633.01 Write-up: CDC Reports: 2mo infant received DTP/OPV on 27SEP89 and died 29SEP89. |
|
VAERS ID: |
26294 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: |
1990-01-23 |
Onset: |
1990-01-24 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256959 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0594F / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-01-24
Days after onset: 0 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: No illness following previous immunization. Allergies: Diagnostic Lab Data: CDC Split Type: 9001633.02 Write-up: CDC Reports: 5 mo infant receivd DTP/OPV on 23JAN90 and died 24JAN90. |
|
VAERS ID: |
26295 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: |
1989-11-14 |
Onset: |
1989-11-17 |
Days after vaccination: |
3 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256959 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0593D / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-11-17
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001633.03 Write-up: CDC Reports: 2 mo infant received DTP/OPV on 14NOV89 and died 17NOV89. |
|
VAERS ID: |
26296 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: |
1989-12-12 |
Onset: |
1989-12-12 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256962 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0600H / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-12-12
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001635.01 Write-up: CDC Reports: 3 mo infant received DTP/OPV on 12DEC89 and died same day. Infant was put down for a nap approx 1PM. Mother checked on infant approx 4PM no response dead on arrival at hospital. |
|
VAERS ID: |
26297 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Vermont |
Vaccinated: |
1989-12-14 |
Onset: |
1990-01-01 |
Days after vaccination: |
18 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256959 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
259943 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea, Brain oedema, Hypoxia, Infection, Lung disorder, Petechiae, Respiratory disorder, Sudden infant death syndrome SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-01-01
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: 9001636.01 Write-up: CDC Reports: 2 mo infant received DTP/OPV on 14DEC89 and died 1JAN90. |
|
VAERS ID: |
26318 (history) |
Form: |
Version 1.0 |
Age: |
92.0 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: |
1990-10-09 |
Onset: |
1990-10-11 |
Days after vaccination: |
2 |
Submitted: |
1990-10-17 |
Days after onset: |
6 |
Entered: |
1990-10-22 |
Days after submission: |
5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11216 / 1 |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-12
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: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet Current Illness: Rt lacunar Infarct Temp Area, Hypertens. Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke Allergies: Diagnostic Lab Data: All lab work WNL CDC Split Type: Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90. |
|
VAERS ID: |
26336 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: |
1990-07-26 |
Onset: |
1990-07-29 |
Days after vaccination: |
3 |
Submitted: |
1990-10-23 |
Days after onset: |
86 |
Entered: |
1990-10-25 |
Days after submission: |
2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0603D / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Agitation, Pyrexia, Sudden infant death syndrome SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-07-29
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS. CDC Split Type: Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3. |
|
VAERS ID: |
26483 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Unknown |
Location: |
Connecticut |
Vaccinated: |
1989-07-27 |
Onset: |
0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
244984 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
250939 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion, Hypertonia, Insomnia, Screaming, Vomiting SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-04-18 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: Allergies: Diagnostic Lab Data: CDC Split Type: 900157501 Write-up: Pt vaccinated with 1st DTP/OPV on 27Jul89, developed loss of head control, screaming & vomiting, had sleep loss, limbs tense and developed seizures. Hospitalized many times between Sep-Dec89, received DT, condition worsened; Died 18APR90. |
|
VAERS ID: |
26463 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: |
1990-10-01 |
Onset: |
1990-10-01 |
Days after vaccination: |
0 |
Submitted: |
1990-10-17 |
Days after onset: |
16 |
Entered: |
1990-11-02 |
Days after submission: |
16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908209 / UNK |
LA / IM |
Administered by: Private Purchased by: Other Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-16
Days after onset: 15 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE SPECIFIED Current Illness: CANCER Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR Allergies: Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM CDC Split Type: 890291001B Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX |
|
VAERS ID: |
26484 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
1990-09-27 |
Onset: |
0000-00-00 |
Submitted: |
1990-10-30 |
Entered: |
1990-11-05 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / 4 |
- / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Agitation, Apnoea, Cardiac arrest, Chills, Pain, Pyrexia, Vasodilatation SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-06 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV/HIB/MMR found apneic in crib on 06OCT90. |
|
VAERS ID: |
26592 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: |
1990-10-03 |
Onset: |
1990-10-26 |
Days after vaccination: |
23 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11070 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Estrace Cream Current Illness: Preexisting Conditions: Premature birth 2lbs 13 oz Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type: Write-up: Pt vaccinated with PROHIBIT DOA to Hosp. |
|
VAERS ID: |
26593 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1990-10-29 |
Onset: |
1990-10-31 |
Days after vaccination: |
2 |
Submitted: |
1990-11-02 |
Days after onset: |
2 |
Entered: |
1990-11-08 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0G11097 / UNK |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-31
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Nystatin Ointment Current Illness: Diaper Rash Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV no adverse effects according to father; Pt was fine the day after immunization. Pt discovered not breathing at 2AM 31OCT. |
|
VAERS ID: |
26603 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: |
1990-10-24 |
Onset: |
1990-10-29 |
Days after vaccination: |
5 |
Submitted: |
1990-11-05 |
Days after onset: |
7 |
Entered: |
1990-11-09 |
Days after submission: |
4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0A21149 / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0611B / 2 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-29
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Proventil Syrup, Terbutaline Current Illness: BPD, Oxygen Dependency Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type: Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome. |
|
VAERS ID: |
26655 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: |
1990-10-18 |
Onset: |
1990-10-25 |
Days after vaccination: |
7 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F112117 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia, Back pain SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Calan SR 240MG 1/2 tab daily. Current Illness: Preexisting Conditions: Hx of hypertension, cigarette smoking. Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain. |
|
VAERS ID: |
26668 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Unknown |
Location: |
New York |
Vaccinated: |
1990-11-08 |
Onset: |
1990-11-11 |
Days after vaccination: |
3 |
Submitted: |
1990-11-13 |
Days after onset: |
2 |
Entered: |
1990-11-16 |
Days after submission: |
3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0C21132 / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Bronchitis, Laryngitis, Otitis media, Pharyngitis, Pyrexia SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-11-11
Days after onset: 0 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: Mild cold Preexisting Conditions: normal child Allergies: Diagnostic Lab Data: CDC Split Type: CO3705 Write-up: Pt vaccinated with PROHIBIT mild cold at time of injection. Seen again 11NOV for subjective fever, worsening cold tugging at ears. Dx w/Otitis. Prescribed Augmentin, Codeine & Tylenol. Child found dead 6 hrs later in bed. Normal child |
|
VAERS ID: |
26694 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: |
1990-09-10 |
Onset: |
0000-00-00 |
Submitted: |
1990-11-16 |
Entered: |
1990-11-21 |
Days after submission: |
5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285968 / 1 |
- / IM L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
283949 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (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: 1990-10-13 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: Chronic CNS Disease Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia Allergies: Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia. CDC Split Type: Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death. |
|
VAERS ID: |
26713 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: |
1990-10-02 |
Onset: |
1990-10-02 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
02580P / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-09
Days after onset: 7 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, ? days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems. Allergies: Diagnostic Lab Data: CDC Split Type: 904090003 Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90. |
|
VAERS ID: |
26714 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1990-10-15 |
Onset: |
1990-10-21 |
Days after vaccination: |
6 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285968 / UNK |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0620D / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-21
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV mother put to bed at 10PM for the night. Found pt. at 5AM cold & stiff on 21OCT90. |
|
VAERS ID: |
26715 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1990-11-07 |
Onset: |
1990-11-10 |
Days after vaccination: |
3 |
Submitted: |
1990-11-20 |
Days after onset: |
10 |
Entered: |
1990-11-26 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256964 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
257190 / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-11-10
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Autopsey CDC Split Type: Write-up: Pt vaccinated with DTP/OPV SIDS presumed as of this date pending coronor''s report. |
|
VAERS ID: |
26721 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Male |
Location: |
Iowa |
Vaccinated: |
1990-10-24 |
Onset: |
1990-11-02 |
Days after vaccination: |
9 |
Submitted: |
1990-11-14 |
Days after onset: |
12 |
Entered: |
1990-11-26 |
Days after submission: |
12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908187 / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, ? days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation. CDC Split Type: Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS. |
|
VAERS ID: |
26799 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: |
1990-09-24 |
Onset: |
1990-09-26 |
Days after vaccination: |
2 |
Submitted: |
1990-11-20 |
Days after onset: |
55 |
Entered: |
1990-11-27 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
281946 / 1 |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Hydronephrosis SMQs:, Retroperitoneal fibrosis (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-09-26
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV child died. Autopsy showed baby had one kidney with chronic type changes, damage, hydronephrosis. |
|
VAERS ID: |
26890 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: |
0000-00-00 |
Onset: |
1990-01-25 |
Submitted: |
0000-00-00 |
Entered: |
1990-12-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256960 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
256930 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pneumonia, Sudden infant death syndrome SMQs:, Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-01-25
Days after onset: 0 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: Allergies: Diagnostic Lab Data: Post mortem - "slight pneumonia" CDC Split Type: Write-up: Pt vax with DTP/OPV was doing well on 25JAN90 taken to sitter. Found dead in crib in afternoon. |
|
VAERS ID: |
27000 (history) |
Form: |
Version 1.0 |
Age: |
28.0 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: |
1989-08-15 |
Onset: |
1989-08-15 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-12-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
241916 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Cardiac arrest, Dyspnoea, Neuropathy, Paraesthesia, Pneumonia, Pneumothorax, Urinary tract infection SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: Allergies: Diagnostic Lab Data: Autopsy report dx: acute inflammatory polyneuropathy, interstitial pneumonitis, urinary tract infection, pneumothorax, cytomegalovirus infection, Epstein-Barr virus infection & cardiorespiratory arrest. CDC Split Type: 890189201 Write-up: Pt vaccinated with TD c/o numbness of hand & feet 24-48 hrs after vaccination, decreased sensation in both feet (to pinprick), developed polyneuropathy & required mechanical ventilation, developed respiratory distress, suffered CR arrest. |
|
VAERS ID: |
26973 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
1990-07-17 |
Onset: |
1990-07-28 |
Days after vaccination: |
11 |
Submitted: |
1990-11-20 |
Days after onset: |
115 |
Entered: |
1990-12-12 |
Days after submission: |
22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
9B11095 / 1 |
LA / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
275910 / 3 |
MO / PO |
Administered by: Public Purchased by: Unknown Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? Yes Birth Defect? No Died? Yes
Date died: 1990-07-28
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CA9017 Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia. |
|
VAERS ID: |
26994 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: |
1990-11-20 |
Onset: |
1990-11-22 |
Days after vaccination: |
2 |
Submitted: |
1990-12-06 |
Days after onset: |
14 |
Entered: |
1990-12-14 |
Days after submission: |
8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285915 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277949 / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Apnoea, Sudden infant death syndrome SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-11-22
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: PA907 Write-up: Pt vaccinated with DTP/OPV child in bed w/parents - not breathing - taken to ER Indiana. Autopsy done - Dx SIDS |
|
VAERS ID: |
27141 (history) |
Form: |
Version 1.0 |
Age: |
84.0 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: |
1990-10-22 |
Onset: |
1990-10-22 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1990-12-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
287974 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Nausea, Pain SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-25
Days after onset: 3 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: rash /w penicillin Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died |
|
VAERS ID: |
27153 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Unknown |
Location: |
Ohio |
Vaccinated: |
0000-00-00 |
Onset: |
0000-00-00 |
Submitted: |
1990-12-05 |
Entered: |
1990-12-21 |
Days after submission: |
16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / UNK |
- / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: Allergies: Diagnostic Lab Data: CDC Split Type: CO3729 Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection. |
|
VAERS ID: |
27159 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
North Carolina |
Vaccinated: |
1990-11-26 |
Onset: |
0000-00-00 |
Submitted: |
1990-12-17 |
Entered: |
1990-12-26 |
Days after submission: |
9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
OF11208 / UNK |
- / - |
Administered by: Private Purchased by: Public Symptoms: Bronchitis, Cough, Influenza SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-12 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA) Current Illness: ganglion wrist Preexisting Conditions: Penicillin by hx Allergies: Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative CDC Split Type: Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later. |
|
VAERS ID: |
27160 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1990-12-18 |
Onset: |
1990-12-18 |
Days after vaccination: |
0 |
Submitted: |
1990-12-19 |
Days after onset: |
1 |
Entered: |
1990-12-26 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / 2 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M730FE / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0615A / 2 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-18
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Caldesene cream Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV/HIB expired 7 hrs later. Dx SIDS. |
|
VAERS ID: |
27161 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: |
1990-12-11 |
Onset: |
1990-12-12 |
Days after vaccination: |
1 |
Submitted: |
1990-12-17 |
Days after onset: |
5 |
Entered: |
1990-12-26 |
Days after submission: |
9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB |
DTP272 / UNK |
LL / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M190FD / UNK |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287952 / UNK |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-12
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS. |
|
VAERS ID: |
27246 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: |
1990-12-14 |
Onset: |
1990-12-15 |
Days after vaccination: |
1 |
Submitted: |
1990-12-17 |
Days after onset: |
2 |
Entered: |
1990-12-31 |
Days after submission: |
14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271916 / 2 |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287951 / 2 |
MO / PO |
Administered by: Private Purchased by: Other Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-15
Days after onset: 0 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: This was an adopted infant born at Tacoma General Hosp Allergies: Diagnostic Lab Data: CDC Split Type: WA90499 Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS |
|
VAERS ID: |
27275 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: |
1990-11-26 |
Onset: |
1990-11-26 |
Days after vaccination: |
0 |
Submitted: |
1990-12-26 |
Days after onset: |
30 |
Entered: |
1991-01-02 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01870P / UNK |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Apnoea, Cardiac arrest SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-11-26
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Ascriptin, Metamucil Current Illness: Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face. Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired. |
|
VAERS ID: |
27309 (history) |
Form: |
Version 1.0 |
Age: |
0.18 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
1990-12-06 |
Onset: |
1990-12-12 |
Days after vaccination: |
6 |
Submitted: |
1990-12-21 |
Days after onset: |
9 |
Entered: |
1991-01-04 |
Days after submission: |
14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
291930 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
285951 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-12
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Pathology report by Hosp. CDC Split Type: Write-up: Pt vaccinated with DTP/OPV sudden infant death. |
|
VAERS ID: |
27313 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Male |
Location: |
West Virginia |
Vaccinated: |
1989-07-17 |
Onset: |
1990-12-03 |
Days after vaccination: |
504 |
Submitted: |
1990-12-27 |
Days after onset: |
24 |
Entered: |
1991-01-07 |
Days after submission: |
11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8J01171 / 1 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-05
Days after onset: 2 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: Allergies: Diagnostic Lab Data: Blood Culture positive for H. Influenza type B CDC Split Type: CO3731 Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency. |
|
VAERS ID: |
27341 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1990-12-27 |
Onset: |
1990-12-29 |
Days after vaccination: |
2 |
Submitted: |
1991-01-03 |
Days after onset: |
5 |
Entered: |
1991-01-08 |
Days after submission: |
5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283910 / UNK |
- / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M6507B / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
06137 / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Cyanosis SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-29
Days after onset: 0 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: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib. |
|
VAERS ID: |
27451 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: |
1990-11-20 |
Onset: |
1990-11-29 |
Days after vaccination: |
9 |
Submitted: |
1991-01-08 |
Days after onset: |
40 |
Entered: |
1991-01-17 |
Days after submission: |
9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0L11101 / 2 |
LL / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M030FC / 1 |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0619L / 2 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-11-29
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: None Current Illness: None Preexisting Conditions: Allergies: Diagnostic Lab Data: SIDS investigation & autopsy done CDC Split Type: Write-up: Dx sudden infant death syndrome died 29Nov90 |
|
VAERS ID: |
27453 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: |
1990-08-14 |
Onset: |
1990-08-22 |
Days after vaccination: |
8 |
Submitted: |
1991-01-08 |
Days after onset: |
139 |
Entered: |
1991-01-18 |
Days after submission: |
10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / 2 |
LL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
253948 / 2 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Coma, Dehydration, Diarrhoea, Hypotonia, Muscle atrophy, Pallor, Paralysis, Pyrexia, Renal failure, Sepsis SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad) Life Threatening? Yes Birth Defect? No Died? Yes
Date died: 1990-08-22
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 21 days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Surgery Jul90 for incarcarated hernia. Allergies: Diagnostic Lab Data: CDC Split Type: AZ9101 Write-up: 1 wk following DTP/OPV #2 developed explosive diarrhea & temp 106.1, pale, unresponsive, kidney failure. Dx severe blood infection/diarrhea & dehydration was on peritoneal dialysis. Also dx w/ Wernig Hoffman Disease. |
|
VAERS ID: |
27506 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: |
1991-01-08 |
Onset: |
1991-01-09 |
Days after vaccination: |
1 |
Submitted: |
1991-01-10 |
Days after onset: |
1 |
Entered: |
1991-01-22 |
Days after submission: |
12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
293947 / 2 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M705FE / 1 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291964 / 2 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-09
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol drops PRN Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91 CDC Split Type: VA91001 Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue. |
|
VAERS ID: |
27509 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Alaska |
Vaccinated: |
1991-01-14 |
Onset: |
1991-01-15 |
Days after vaccination: |
1 |
Submitted: |
1991-01-17 |
Days after onset: |
2 |
Entered: |
1991-01-22 |
Days after submission: |
5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1726S / 1 |
LL / IM |
Administered by: Public Purchased by: Public Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-15
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Received BPIG (IND drug) by Mass Biologic Labs, Lot #8, IM, RL, 1 prev dose at same time as HIB. Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: autopsy pending CDC Split Type: Write-up: Received PRP-OMP & BPIG (IND drug) after being evaluated & found afeb. & in good health. Infant was found apneic in his bed the next AM. |
|
VAERS ID: |
27510 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
1990-12-21 |
Onset: |
1990-12-22 |
Days after vaccination: |
1 |
Submitted: |
1991-01-16 |
Days after onset: |
25 |
Entered: |
1991-01-22 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M730FF / 1 |
RL / - |
Administered by: Private Purchased by: Unknown Symptoms: Abdominal distension, Apnoea, Brain oedema, Haemorrhage, Haemothorax, Lung disorder, Pulmonary oedema, Sudden infant death syndrome SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-22
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Pedi-Care Decongestant Drops Current Illness: Decongested Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt given HIB titer 21DEC90 aprox 1230PM pt died 22DEC90 738 HRS.F/U 19Apr91 Autopsy rept-Acute respiratory failure,SIDS.Petechial hemorrhages of pleurae,epicardium & thymus.Pulmonary/cerebral edema &congestion.Congestion of abdo viscera. |
|
VAERS ID: |
27526 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: |
1990-12-22 |
Onset: |
1990-12-31 |
Days after vaccination: |
9 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea, Bronchitis, Cardiac failure, Coagulopathy, Convulsion, Infection, Pharyngitis, Pneumonia, Pyrexia, Rash, Renal failure, Sepsis, Shock SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, ? days Extended hospital stay? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES91010158 Write-up: Developed T,convuls&pneumonia.Hospitalized w/ septic shock, renal failure & disseminated intravascular coagulation.Develop rash&tracheitis.Culture-Staph aureus.Exp multiple system failure-renal/respiratory/metabolic/cardivascul.Died 11Jan91 |
|
VAERS ID: |
27529 (history) |
Form: |
Version 1.0 |
Age: |
78.0 |
Sex: |
Female |
Location: |
New Hampshire |
Vaccinated: |
1990-11-06 |
Onset: |
1990-11-07 |
Days after vaccination: |
1 |
Submitted: |
1991-01-18 |
Days after onset: |
72 |
Entered: |
1991-01-24 |
Days after submission: |
6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11226 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Right ventricular failure SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-10
Days after onset: 33 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: Allergies: Diagnostic Lab Data: CDC Split Type: CO3759 Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms. |
|
VAERS ID: |
27690 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Florida |
Vaccinated: |
1991-01-18 |
Onset: |
1991-01-25 |
Days after vaccination: |
7 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-01 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / 1 |
LL / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M190FD / 1 |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0623A / 1 |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-25
Days after onset: 0 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: High T-4 lst PKU - Normal testing results rec. Allergies: Diagnostic Lab Data: Autopsy Done-no results at this time CDC Split Type: Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91 |
|
VAERS ID: |
27691 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: |
1991-01-17 |
Onset: |
1991-01-23 |
Days after vaccination: |
6 |
Submitted: |
1991-01-24 |
Days after onset: |
1 |
Entered: |
1991-02-01 |
Days after submission: |
8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0A21149 / 3 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M090FF / 2 |
RL / IM |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-23
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Septra Current Illness: otitis media Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy - no evidence for abnormalities. CDC Split Type: Write-up: Crib Death; Felt to be sids. |
|
VAERS ID: |
28070 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
South Dakota |
Vaccinated: |
1990-10-12 |
Onset: |
1990-10-15 |
Days after vaccination: |
3 |
Submitted: |
1991-01-10 |
Days after onset: |
87 |
Entered: |
1991-02-12 |
Days after submission: |
33 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285920 / 1 |
LL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0614E / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-15
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: None Current Illness: No Preexisting Conditions: None Allergies: Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect. CDC Split Type: SD91002 Write-up: SIDS. |
|
VAERS ID: |
28073 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: |
1990-12-19 |
Onset: |
1990-12-22 |
Days after vaccination: |
3 |
Submitted: |
1990-12-26 |
Days after onset: |
4 |
Entered: |
1991-02-12 |
Days after submission: |
48 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0F11081 / 1 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M190FO / 1 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291938 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-22
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: In sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling Other Medications: None Current Illness: None Preexisting Conditions: Resolved otitis media Allergies: Diagnostic Lab Data: Autopsy consistent with SIDS. CDC Split Type: Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome. |
|
VAERS ID: |
28546 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Male |
Location: |
D.C. |
Vaccinated: |
1990-05-24 |
Onset: |
1990-05-26 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8L01023 / UNK |
RA / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Infection, Meningitis SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 0000-00-00 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: not available Allergies: Diagnostic Lab Data: not available CDC Split Type: CO3506 Write-up: Pt died; Meningococcal meningitis; Culture proven Neissera; |
|
VAERS ID: |
28091 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: |
1990-10-09 |
Onset: |
1990-10-09 |
Days after vaccination: |
0 |
Submitted: |
1991-02-07 |
Days after onset: |
121 |
Entered: |
1991-02-14 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283914 / 1 |
RL / - |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome, Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-10-14
Days after onset: 5 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol Current Illness: None Preexisting Conditions: lt congenital hip dysplasia Allergies: Diagnostic Lab Data: Cause of death SIDS - no autopsy performed. CDC Split Type: Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax. |
|
VAERS ID: |
28321 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: |
1991-02-05 |
Onset: |
1991-02-06 |
Days after vaccination: |
1 |
Submitted: |
1991-02-07 |
Days after onset: |
1 |
Entered: |
1991-02-15 |
Days after submission: |
8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285918 / 1 |
LL / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M200FE / 1 |
LL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291938 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-02-06
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol poss. Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: Autopsy-$g no cause found CDC Split Type: Write-up: sids death 16-24 hrs /p administration of imm. |
|
VAERS ID: |
28327 (history) |
Form: |
Version 1.0 |
Age: |
1.2 |
Sex: |
Male |
Location: |
Louisiana |
Vaccinated: |
1990-12-27 |
Onset: |
1991-01-02 |
Days after vaccination: |
6 |
Submitted: |
1991-01-15 |
Days after onset: |
13 |
Entered: |
1991-02-15 |
Days after submission: |
31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
275970 / 2 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287954 / 2 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Agitation, Dehydration, Eye disorder, Pyrexia SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-02
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol Current Illness: Preexisting Conditions: 26 wks preme, hx of hyaline membrane disease, sepsis, necrotizing enterocolitis /w small bowel resec, malabsorption, formula intolerance Allergies: Diagnostic Lab Data: CSF-clear, WBC-0, RBC-5, 0-Segs & Lymphs CDC Split Type: LA910203 Write-up: Mom noted listlessness & dark circles around eyes in am 2Jan, pt taken Hosp arrived @ 11am, found to have T 103, T escalating, pt died @ 1130 am, cause of death - dehydration, No fever noted @ time of Immun. to arrival @ hosp, no neuro S+S |
|
VAERS ID: |
28357 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
1991-01-28 |
Onset: |
1991-01-31 |
Days after vaccination: |
3 |
Submitted: |
1991-02-13 |
Days after onset: |
13 |
Entered: |
1991-02-18 |
Days after submission: |
5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
291931 / 3 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M085FF / 2 |
LL / IM |
Administered by: Private Purchased by: Private Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-31
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: none~ ()~~~In patient Other Medications: none Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids CDC Split Type: Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death. |
|
VAERS ID: |
28432 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: |
1991-01-15 |
Onset: |
1991-01-15 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
293948 / 2 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M090FF / 1 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287942 / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Abdominal distension, Apnoea, Cardiac arrest, Infection, Lung disorder, Personality disorder, Pulmonary oedema SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-01-15
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: no~ ()~~~In patient Other Medications: synthroid Current Illness: hypothyroidism, cranialsynostosis, herni Preexisting Conditions: hypothyroidism, cranialsynostosis, hernia repair X 2, bronchopulmanary dysplasia Allergies: Diagnostic Lab Data: blood drawn post immun-all normal, blood drawn in ER possible for alpha strep CDC Split Type: CT911 Write-up: pulmonary congestion & edema,bronchopulmonary dysplasia, Child not acting right all day, as per family, stopped breathing in front of mom, found in cardiac arrest by EMT who began CPR,pt found /w distended abdomen, decompressed manually |
|
VAERS ID: |
28514 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: |
1989-12-14 |
Onset: |
1989-12-15 |
Days after vaccination: |
1 |
Submitted: |
1991-02-25 |
Days after onset: |
437 |
Entered: |
1991-03-01 |
Days after submission: |
4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283914 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
253938 / UNK |
- / - |
Administered by: Private Purchased by: Other Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1989-12-23
Days after onset: 8 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: NA~ ()~~~In patient Other Medications: NA Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding. |
|
VAERS ID: |
28519 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: |
1990-11-29 |
Onset: |
1990-12-16 |
Days after vaccination: |
17 |
Submitted: |
1991-02-01 |
Days after onset: |
47 |
Entered: |
1991-03-01 |
Days after submission: |
28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283913 / 2 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
285949 / 2 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1990-12-16
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: IL913 Write-up: SIDS- 16DEC90. |
|
VAERS ID: |
28528 (history) |
Form: |
Version 1.0 |
Age: |
0.6 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: |
1991-02-18 |
Onset: |
1991-02-18 |
Days after vaccination: |
0 |
Submitted: |
1991-02-19 |
Days after onset: |
1 |
Entered: |
1991-03-01 |
Days after submission: |
10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0C21045 / 3 |
- / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M635FN / 3 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Convulsion SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 1991-02-18
Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: ~ ()~~~In patient Other Medications: Digoxin, aspirin Current Illness: Preexisting Conditions: Congental Heart Disease Allergies: Diagnostic Lab Data: CDC Split Type: CO3790 Write-up: Expired p/having sz. Occurred 5 hrs post vax. |
|