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VAERS ID: 69984 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Colorado  
Vaccinated:1994-11-16
Onset:1994-11-25
   Days after vaccination:9
Submitted: 1994-12-06
   Days after onset:11
Entered: 1995-01-03
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51125 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4J51125 / UNK LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 374931 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Bronchiolitis, Bronchitis, Cough, Diarrhoea, Infection, Laryngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-28
   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: unk
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO94080

Write-up: pt recvd vax; to er w/ URI sxs & died on 27nov; obituary did follow; final dx streptococcal epiglottitis; lung biopsy demonstrated possible H influenza;


VAERS ID: 69993 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1994-12-01
Onset:1994-12-08
   Days after vaccination:7
Submitted: 1994-12-14
   Days after onset:6
Entered: 1995-01-03
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4C51005 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1547W / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380939 / 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: 1994-12-08
   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: OH94130

Write-up: pt recvd vax; SIDS death; no sxs in the wk prior to death according to ofc; parent just found baby;


VAERS ID: 70011 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Florida  
Vaccinated:1994-12-19
Onset:1994-12-21
   Days after vaccination:2
Submitted: 1994-12-21
   Days after onset:0
Entered: 1995-01-04
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380971 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382999 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recvd vaxpt not responsive upon arrival at hosp; found in crib wrapped in blanket,not breathing;unable to rescuscitate;coroners case, pending autopsy report;


VAERS ID: 70240 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:1994-11-10
Onset:1994-11-17
   Days after vaccination:7
Submitted: 1994-12-15
   Days after onset:28
Entered: 1995-01-09
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51025 / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Influenza, Myocardial infarction, Nausea, Pericardial effusion, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-04
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: unk
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA94160

Write-up: pt recvd vax;began to exp n & v along w/ sxs of the flu;sxs cont until death;pt did not seek med help;cause of death cardiac tamponade due to ruptured myocardial infarction & coronary atherosclerosis;


VAERS ID: 70256 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Nebraska  
Vaccinated:1994-12-08
Onset:0000-00-00
Submitted: 1994-12-30
Entered: 1995-01-09
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51107 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0570A / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51107 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0710L / 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: 1994-12-28
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:
Allergies:
Diagnostic Lab Data: autopsy in progress
CDC Split Type: NE9427

Write-up: Babysitter found pt expired 6AM 28DEC94;


VAERS ID: 70295 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1991-05-24
Onset:1991-05-24
   Days after vaccination:0
Submitted: 1995-01-02
   Days after onset:1319
Entered: 1995-01-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 2 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M170HB / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295949 / 2 - / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Bronchitis, Chills, Convulsion, Crying, Malaise, Otitis media
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-31
   Days after onset: 7
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: had a cold exactly one month prior vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: high pitched screaming, convuls, lifeless, very cold reaction started 2hrs or so p/shot; took to MD few days later had ear infect & probable bronchitis; was prescribed Rondec & amoxicillian; next day pt died;


VAERS ID: 70531 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Mexico  
Vaccinated:1994-12-16
Onset:1994-12-16
   Days after vaccination:0
Submitted: 1994-12-19
   Days after onset:3
Entered: 1995-01-11
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386986 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1605B2 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 378951 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Crying, Encephalopathy, Insomnia, Petechiae, Pyrexia, Screaming, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), 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: 1994-12-18
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 16DEC94 in the afternoon; mom says pt cried & screamed nearly continually thereafter sleeping for less than an hr @ a time until went to sleep 0200AM 18DEC & was found @ 0400 dead in bed; slept 2 hrs p/vax then started crying;


VAERS ID: 70545 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: North Carolina  
Vaccinated:1994-12-13
Onset:1994-12-16
   Days after vaccination:3
Submitted: 1994-12-16
   Days after onset:0
Entered: 1995-01-12
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 381900 / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 378940 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Infection, Pyrexia, Sepsis, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (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: 1994-12-16
   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:
Current Illness: URI per mom
Preexisting Conditions: NKA 2 prev febrile illness w/high fevers
Allergies:
Diagnostic Lab Data: BCX pos meth resistant staph (coag pos);
CDC Split Type: NC95001

Write-up: pt w/URI sx, s/p vax 13DEC94; mom gave APAP x 48 hrs; unsure when pt became febrile; found blue & apneic in bed 16DEC94 early AM; EMT''s found in full cardioresp arrest & intubated & initiated CPR; temp on arrival in ER 104.1 p/45 mins dead;


VAERS ID: 70603 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-06-24
Onset:1994-07-13
   Days after vaccination:19
Submitted: 1994-12-29
   Days after onset:169
Entered: 1995-01-17
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1547W / 1 RL / IM

Administered by: Public       Purchased by: Other
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-07-13
   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: ampicillin; phytonactione,lotycin ophthalmic;
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94027

Write-up: pt recvd vax;COD SIDS;


VAERS ID: 70689 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1994-12-21
Onset:0000-00-00
Submitted: 1995-01-10
Entered: 1995-01-20
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51006 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0656A / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0711M / 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: 1995-01-10
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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type: OK951

Write-up: pt recvd vax; unexplained death; SIDS;


VAERS ID: 70705 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:1994-11-04
Onset:1994-11-04
   Days after vaccination:0
Submitted: 1995-01-18
   Days after onset:75
Entered: 1995-01-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51165 / 2 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Convulsion, Headache, Intracranial aneurysm, Malaise, Subarachnoid haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 13
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: NONE
Preexisting Conditions: heart condition not requiring medication
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5678

Write-up: h/a; severe enough that needed to lie down in the evening of 7NOV994; also had general malaise; c/o h/a started the same day of vax 4NOV94; 10NOV94 pt exp sz, then passed out; sx ruptured cerebral aneurysm; pt had surgery 11NOV94 & died;


VAERS ID: 70723 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Connecticut  
Vaccinated:1995-01-13
Onset:1995-01-13
   Days after vaccination:0
Submitted: 1995-01-19
   Days after onset:6
Entered: 1995-01-23
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372935 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0048A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-13
   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: well 2mo old
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt arrived @ ER DOA:


VAERS ID: 70772 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1994-09-23
Onset:1994-09-24
   Days after vaccination:1
Submitted: 1994-10-25
   Days after onset:31
Entered: 1995-01-25
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369909 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696M / 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: 1994-09-24
   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: none
Current Illness: none
Preexisting Conditions: birth by C section
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94167

Write-up: pt recvd vax;dad checked pt 24sep at 1am,blood in mouth & nose; pt blue & not breathing;to er & pronounced dead at 2am;er report,death certificate & autopsy report to follow;


VAERS ID: 70777 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1994-11-04
Onset:1994-11-10
   Days after vaccination:6
Submitted: 1994-11-16
   Days after onset:6
Entered: 1995-01-25
   Days after submission:70
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372933 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0701D / 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: 1994-11-10
   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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94172

Write-up: pt recvd vax; obituary in newspaper, unable to contact par by phone


VAERS ID: 71049 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Mississippi  
Vaccinated:1995-01-13
Onset:1995-01-14
   Days after vaccination:1
Submitted: 1995-01-20
   Days after onset:6
Entered: 1995-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372934 / 2 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382945 / 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: 1995-01-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: na~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: MS95002

Write-up: pt recvd vax;mom had pt down for an afternoon nap;when checked on pt,found him dead;to er; possible SIDS; no oth; sxs were reported;


VAERS ID: 71056 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Texas  
Vaccinated:1994-11-10
Onset:1994-12-03
   Days after vaccination:23
Submitted: 1994-12-05
   Days after onset:2
Entered: 1995-01-27
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380998 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0570A / 3 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703C / 3 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: 1994-12-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: TX94525

Write-up: pt recvd vax; DOA in er 3dec94; autopsy pending;


VAERS ID: 71073 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Minnesota  
Vaccinated:1995-01-17
Onset:1995-01-20
   Days after vaccination:3
Submitted: 1995-01-23
   Days after onset:3
Entered: 1995-01-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380997 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0709H / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Somnolence, Sudden infant death syndrome
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-20
   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: NONE
Preexisting Conditions: agenesis of corpus callosum
Allergies:
Diagnostic Lab Data: MRI 5DEC95;
CDC Split Type:

Write-up: pt recvd vax 17JAN95 pt died on 20JAN95 preliminary autopsy finding consistent w/SIDS; final report pending; parents report pt was cranky p/vax slep more following day; on 20JAN95 seem well; PMH pos agenesis corpus callosum; balanced trans


VAERS ID: 71100 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Male  
Location: Montana  
Vaccinated:1994-12-06
Onset:1995-01-16
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 1995-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES TR1223B53 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0384A / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356943 / 1 MO / PO

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: 1995-01-16
   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: MT95001

Write-up: pt recvd vax;no adverse rxn reported by PAR to hlth dept; pt died on 16jan95;COD undetermined at time of this report filing;


VAERS ID: 71101 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-09-21
Onset:1994-10-23
   Days after vaccination:32
Submitted: 1995-01-20
   Days after onset:89
Entered: 1995-01-30
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51020 / 3 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH M560KF / 3 RL / -

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: 1994-10-23
   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 pt, rxn to vax;~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH95001

Write-up: pt recvd vax; exp apparent sids 23oct94;


VAERS ID: 71272 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Colorado  
Vaccinated:1994-10-19
Onset:1994-10-19
   Days after vaccination:0
Submitted: 1994-12-05
   Days after onset:47
Entered: 1995-02-03
   Days after submission:60
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01764P / 1 - / A

Administered by: Other       Purchased by: Other
Symptoms: Blood creatinine increased, Blood fibrinogen decreased, Blood urea increased, Coagulopathy, Hypotension, Infection, Leukocytosis, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-26
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Feeling slightly ill;
Preexisting Conditions: No spleen; hx of asthma, hx of positive HIV test; hypertension; gout;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax in the AM & reportedly devel fever that evening; was admitted to hosp during the next week & died exactly 1 wk from the vax date reportedly of a bacterial infect in blood;


VAERS ID: 71321 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1995-01-24
Onset:1995-01-27
   Days after vaccination:3
Submitted: 1995-01-27
   Days after onset:0
Entered: 1995-02-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372935 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380949 / 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: 1995-01-27
   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: none
Preexisting Conditions: lsom 16jan95;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; to er; was unresponsive & hypothermic; resucitation unsuccessful;


VAERS ID: 71332 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1994-07-26
Onset:1994-08-01
   Days after vaccination:6
Submitted: 1995-01-29
   Days after onset:181
Entered: 1995-02-07
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Crying, Hypokinesia, Hypotonia, Pallor, Pyrexia, Screaming, Somnolence, Weight decreased
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (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: pt recvd vax 18AUG94 exp did not move, slep alot, unconsolable, stool was runny;~ ()~~~In patient
Other Medications: MIV Vitamins drops; Glycerin suppositories; Nystatin oral suspension
Current Illness: Thrush, yeast infect
Preexisting Conditions: hirschsprung disease/hypospadias/RDS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dec in muscle tone, persistent unconsolable crying was very faint; did not move, would sleep alot; sometimes fever; slowly lost weight, would not move, pale, neck skinny & wrinkled; pt would cry all day; faint & hoarse;


VAERS ID: 71338 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Georgia  
Vaccinated:1995-01-03
Onset:1995-01-08
   Days after vaccination:5
Submitted: 1995-01-09
   Days after onset:1
Entered: 1995-02-07
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369909 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 3 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0701D / 2 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: 1995-01-08
   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: NONE
Preexisting Conditions: premature
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA95002

Write-up: mom went to check on pt 330AM 8JAN95 & pt was not breathing-mom dialled 911-paramedics did not attempt CPR, they said pt had been dead a while;-pt was a twin brother; coroner''s office state COD poss SIDS;


VAERS ID: 72312 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-11-05
Onset:1994-11-15
   Days after vaccination:10
Submitted: 1994-11-30
   Days after onset:15
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), 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: 1994-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: Alzheimer''s disease;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343010S

Write-up: pt recvd vax & devel upper-resp symptoms with congestion, elevated temp, & cough; pt went on to be treated w/ATB;


VAERS ID: 72313 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-27
Onset:1994-11-13
   Days after vaccination:17
Submitted: 1994-11-30
   Days after onset:17
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Dyspnoea, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: Congestive heart failure, anemia, atrial fibrillation;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343011S

Write-up: pt recvd vax & devel upper resp symptoms w/congestion, cough, elevated temp, & shortness of breath; x-ray showed congestive heart failure; Rocephin IM was given;


VAERS ID: 72314 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-13
Onset:1994-11-18
   Days after vaccination:36
Submitted: 1994-11-30
   Days after onset:12
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Hypoxia, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: COPD, diabetes, hypertension, emphysema;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343012S

Write-up: pt recvd vax & devel upper-respiratory symptoms with cough & congestion; oxygen was continued;


VAERS ID: 72315 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-11-08
Onset:1994-11-14
   Days after vaccination:6
Submitted: 1994-11-30
   Days after onset:16
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Angina pectoris, Asthma, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   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: unk
Current Illness: unk
Preexisting Conditions: Arteriosclerotic heart disease, COPD, hypertension, CVA, glaucoma;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343013S

Write-up: pt recvd vax & devel upper-respiratory symptoms with congestion & wheezing; oxygen was continued; cause of death was acute coronary insufficiency;


VAERS ID: 71370 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: Indiana  
Vaccinated:1994-09-29
Onset:1994-12-31
   Days after vaccination:93
Submitted: 1995-01-25
   Days after onset:25
Entered: 1995-02-08
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Thrombotic thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 34483

Write-up: pt recvd vax; devel thrombocytopenia purpura the day p/ vax; pt died at end of dec94 or beginning of jan;MD does not know how thrombocytopenia presented;pt''s daughter said,it was cause of death;


VAERS ID: 71426 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Utah  
Vaccinated:1994-10-28
Onset:1994-11-03
   Days after vaccination:6
Submitted: 1995-01-27
   Days after onset:85
Entered: 1995-02-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51072 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1474W / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Deep vein thrombosis, Hyperkalaemia, Lung neoplasm malignant, Pleural effusion, Pneumonia, Renal failure, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Systemic lupus erythematosus (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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-05
   Days after onset: 32
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: NONE~ ()~~~In patient
Other Medications: Tenex, Procardia, Furosemide, Aludent-Furoxaline
Current Illness: kidney failure, hip replace SEP94
Preexisting Conditions: Kidney failure, hip replacement SEP94, HTN, bilateral pulmonary emboli, mononeuritis multiplex w/muscle atrophy, mesangioglomerulonephritis 2ndary to IgM nephropathy, chronic leukocytosis & elevated creatinine; degenerative joint disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: UT952703

Write-up: wife says flu like sx & SOB hospitalized for pneumonia 22NOV94 x 8 days; readmitted 04DEC94-expired 05DEC94; says had been on meds for kidney failure, HTN-autopsy revealed lung cancer;


VAERS ID: 71553 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kansas  
Vaccinated:1995-01-03
Onset:1995-01-04
   Days after vaccination:1
Submitted: 1995-02-15
   Days after onset:42
Entered: 1995-02-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51055 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1067A / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51055 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384945 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Lung disorder, 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: 1995-01-04
   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: pt recvd HBV by MSD lot# 1067A 27OCT94;
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type: KS95006

Write-up: pt recvd vax 3JAN95 & 4JAN95 expired; final anatomic dx pulmonary edema & congestion & petechial hemorrhages of visceral pleural surfaces; Autopsy reveals death consistent w/SIDS;


VAERS ID: 71826 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-02-09
Onset:1995-02-10
   Days after vaccination:1
Submitted: 1995-02-21
   Days after onset:11
Entered: 1995-02-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380999 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1541W / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386939 / 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: 1995-02-10
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS-pt found by mom (evening following vax administration) unresponsive & blue-ER resusciation efforts unsuccessful


VAERS ID: 71851 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:1995-01-25
Onset:1995-01-27
   Days after vaccination:2
Submitted: 1995-01-30
   Days after onset:3
Entered: 1995-03-01
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-27
   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: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


VAERS ID: 71901 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1994-08-12
Onset:1994-08-12
   Days after vaccination:0
Submitted: 1994-11-18
   Days after onset:98
Entered: 1995-03-03
   Days after submission:105
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358986 / 1 LL / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 358986 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 70602 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Crying, Hypertonia, Hypokinesia, Hypotonia, Pyrexia, Screaming, Somnolence, Sudden infant death syndrome
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-08-30
   Days after onset: 18
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: sleep apnea/monitor ordered
Allergies:
Diagnostic Lab Data: autospy
CDC Split Type:

Write-up: 12-19AUG screaming constant leg, couldn''t move body or cry; 19-30AUG still alot of crying when awoke; excessive sleeping; pt would wake up stiffen body for 30-40seconds then go back to sleep 29th of Aug 102 fever, rash, crying & very limp;


VAERS ID: 71986 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Colorado  
Vaccinated:1994-12-30
Onset:1994-12-31
   Days after vaccination:1
Submitted: 1995-01-09
   Days after onset:9
Entered: 1995-03-09
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384974 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703A / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Hepatocellular damage, Rhinitis, Sudden infant death syndrome
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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: 1994-12-31
   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: none
Current Illness: cold
Preexisting Conditions: born premature 6 wks? no significant neonatal problem;
Allergies:
Diagnostic Lab Data: autopsy pending, perhaps SIDS, on gross showed a liver which appeared infiltrated & kidneys pale suggesting possible metabolic dz; definitive results pending;
CDC Split Type: CO95002

Write-up: Received 2nd set of vaxs on 30DEC94 at 9:30AM; baby found dead by parents at 0730AM on 31DEC94; has twin sibling who also received same vaxs at same time--sibling is fine;


VAERS ID: 72039 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-09-22
Onset:1994-10-18
   Days after vaccination:26
Submitted: 1995-01-25
   Days after onset:99
Entered: 1995-03-13
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 4G51020 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460LA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0700D / UNK - / -

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: 1994-10-18
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94019

Write-up: SIDS-pt died as a result of SIDS;


VAERS ID: 72057 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: Illinois  
Vaccinated:1995-03-03
Onset:1995-03-05
   Days after vaccination:2
Submitted: 1995-03-06
   Days after onset:1
Entered: 1995-03-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51057 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1006A / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4M51118 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384939 / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Haemorrhage, Laryngeal oedema, Lymphadenopathy, Petechiae, Pulmonary oedema, Vasodilatation
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-03-05
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy is pending;
CDC Split Type:

Write-up: no react-no local react, no fever, no fussiness, no drowsiness, no loss of appetite) Sudden death;


VAERS ID: 72141 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1995-03-15
Entered: 1995-03-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Infection, Pneumonia, Sepsis
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
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: growth factor I;insulin-like growth factor I;
Current Illness: HIV pos;
Preexisting Conditions: transfusion acquired HIV, bone age of 12 yrs
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95030243

Write-up: pt recvd vax; pt later became bacteremic & exp pneumonia from serotype 16 pneumococcus;was tx w/ an infusion of intravenous immoglobulin but died 4 days later of serotype 16 pneumococcal sepsis;


VAERS ID: 72146 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: California  
Vaccinated:1995-03-02
Onset:1995-03-03
   Days after vaccination:1
Submitted: 1995-03-03
   Days after onset:0
Entered: 1995-03-21
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 381900 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0713M / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

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: unk~ ()~~~In patient
Other Medications: phenobarbital
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type: 950032801

Write-up: pt recvd vax; found dead next am in foster home;no fever,local rxn or oth sxs following vax;autopsy results pending;


VAERS ID: 72601 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arizona  
Vaccinated:1995-02-06
Onset:1995-02-06
   Days after vaccination:0
Submitted: 1995-02-06
   Days after onset:0
Entered: 1995-03-31
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3D51083 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0744V / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M315LE / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380938 / 1 MO / PO

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: 1995-02-08
   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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: AZ9507

Write-up: pt recvd vax; pt found at home face down, not breathing;


VAERS ID: 72615 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1994-09-08
Onset:1994-09-16
   Days after vaccination:8
Submitted: 1995-02-24
   Days after onset:161
Entered: 1995-03-31
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350919 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-16
   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: na
Current Illness: none
Preexisting Conditions: possible congenital immunosufficiency;(reported at death);
Allergies:
Diagnostic Lab Data: body sent to crime lab;
CDC Split Type: GA95035

Write-up: pt recvd vax;death certificate lists pneumonia as primary COD;


VAERS ID: 72627 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Iowa  
Vaccinated:1995-02-24
Onset:1995-03-06
   Days after vaccination:10
Submitted: 1995-03-07
   Days after onset:1
Entered: 1995-03-31
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384975 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1066A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382943 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: amoxicillin, rondec;
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA95011

Write-up: pt recvd vax; sudden death


VAERS ID: 72629 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Connecticut  
Vaccinated:1994-09-09
Onset:1994-09-09
   Days after vaccination:0
Submitted: 1995-03-20
   Days after onset:192
Entered: 1995-03-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0789A / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0698D / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Aortic valve stenosis, Cardiovascular disorder, Condition aggravated, Congenital anomaly, Crying, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-09-23
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hep B vax 4aug94 from MSD;
Current Illness: peripheral pulmo,suprava aortic stenosis
Preexisting Conditions: peripheral pulmonary stenosis, supravalvular aortic stenosis;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; dec feeding, crying moaning 9sep94;3 hrs p/ vax, lethargic,sleepy, starring,high pitched cry;to MD,stated this was nl response;v & all oth sxs cont until pt brought to Ped cardiologist 14sep94;


VAERS ID: 72631 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Minnesota  
Vaccinated:1995-03-21
Onset:1995-03-22
   Days after vaccination:1
Submitted: 1995-03-23
   Days after onset:1
Entered: 1995-03-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380968 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 713K2 / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Haemorrhage, Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-03-22
   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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: na
CDC Split Type:

Write-up: pt recvd vax; died of sids;


VAERS ID: 72641 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-02-17
Onset:1995-02-22
   Days after vaccination:5
Submitted: 1995-03-13
   Days after onset:19
Entered: 1995-03-31
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 370904 / 4 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Infection, Pyrexia, Rash, Sepsis, Skin discolouration, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), 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: 1995-02-22
   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: none
Current Illness: none
Preexisting Conditions: rt inguinal hernia
Allergies:
Diagnostic Lab Data: cultures shows septicemia due to streptococcus-final report pending
CDC Split Type:

Write-up: pt recvd vax;devel fever on 18feb95;tx w/ fluids & apap;devel rash & d;22feb95 somewhat improved but lethargic;same day was mottled & unresponsive; to er & expired;


VAERS ID: 72796 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Wyoming  
Vaccinated:1995-02-14
Onset:0000-00-00
Submitted: 1995-03-28
Entered: 1995-04-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51146 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1287A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61146 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0711C / 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: 1995-02-22
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:
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WY952

Write-up: pt came to office 14FEB95 for immunization; pt died 22FEB95 dx sid;


VAERS ID: 73024 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1995-03-17
Onset:1995-03-24
   Days after vaccination:7
Submitted: 1995-03-28
   Days after onset:4
Entered: 1995-04-07
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-03-24
   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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


VAERS ID: 73261 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1995-03-20
Onset:1995-03-21
   Days after vaccination:1
Submitted: 1995-03-23
   Days after onset:2
Entered: 1995-04-17
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 394955 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388931 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Haemorrhage, Injury, Petechiae, Pulmonary hypertension, Pyrexia, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-03-21
   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: gentamycin sulphate
Current Illness: discharge fr eye
Preexisting Conditions: premature - 31 wks
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: 950042101

Write-up: pt recvd vax; in eve had a low grade fever;apap given;next am, found dead in crib;no visible abnl; autopsy pending;


VAERS ID: 73262 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Arizona  
Vaccinated:1995-03-21
Onset:1995-03-23
   Days after vaccination:2
Submitted: 1995-03-29
   Days after onset:6
Entered: 1995-04-17
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386986 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386937 / 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: 1995-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: healthy
Preexisting Conditions: healthy
Allergies:
Diagnostic Lab Data: autopsy consistent w/ SIDS;
CDC Split Type: 950047601

Write-up: pt recvd vax; found dead in crib; pt exp no sxs following vax; autopsy consistent w/ sids;


VAERS ID: 73284 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Massachusetts  
Vaccinated:1995-03-31
Onset:1995-04-03
   Days after vaccination:3
Submitted: 1995-04-07
   Days after onset:4
Entered: 1995-04-17
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0449A / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Cyanosis, Stupor, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-04-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Eczema & mild rhinitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SIDS
CDC Split Type:

Write-up: pt was found blue & unresponsive p/put to nap by mom; unsure if this is related to vax but feel that because it was only w/in 7 days perhaps its helpful in statistics;


VAERS ID: 73317 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Massachusetts  
Vaccinated:1995-04-07
Onset:1995-04-08
   Days after vaccination:1
Submitted: 1995-04-13
   Days after onset:5
Entered: 1995-04-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP289 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0538A / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 715L / 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: 1995-04-08
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: apparant SIDS- autopsy results pending;


VAERS ID: 73364 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1995-01-17
Onset:0000-00-00
Submitted: 1995-04-05
Entered: 1995-04-20
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51020 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 17906 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0859A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0700E / 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: 1995-01-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Not known
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA95048

Write-up: Infant fatality Review Committee today made clinic aware of demise of pt on 27JAN95 autopsy findings: SIDS (natural causes);


VAERS ID: 73526 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Male  
Location: Illinois  
Vaccinated:1994-12-09
Onset:1994-12-22
   Days after vaccination:13
Submitted: 1995-04-15
   Days after onset:113
Entered: 1995-04-25
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV: JAPANESE ENCEPHALITIS (J-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Cardiac failure, Cerebral ischaemia, Condition aggravated, Hepatomegaly, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-03
   Days after onset: 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:
Current Illness: DORV, s/p rastelli procedure, ventric,
Preexisting Conditions: DORV, hx of complex congenital heart disease--Double Outlet Right Ventricle with VSD (Taussig-Bing Type) & pulmonary stenosis; S/P Rastelli Procedure (1989), S/P transverse pacemaker placement (1989);
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had syncopal episode @ school, p/receiving vax 28NOV94 & 09DEC94; found w/in 2 mins to be apnic w/no carotid pulse; CPR done by school nurse almost immed; sent to hosp, ped ICU pt expired 3JAN95;


VAERS ID: 73572 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1994-08-25
Onset:1994-08-28
   Days after vaccination:3
Submitted: 1995-04-19
   Days after onset:234
Entered: 1995-04-28
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0443A / 2 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460LA / 1 - / IM A
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703B / 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: 1994-08-28
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: neonatal screen-WNL
CDC Split Type:

Write-up: pt found unresponsive @ home; EMT;s called transferred to ER; attempted resuscitation efforts unsuccessful; pronounced dead in ER:


VAERS ID: 73937 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1995-04-25
Onset:0000-00-00
Submitted: 1995-05-01
Entered: 1995-05-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426118 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1649A2 / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 394924 / UNK 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: 1995-04-26
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS (coroner''s report) 24 hr p/vax;


VAERS ID: 73971 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1995-04-11
Onset:1995-04-20
   Days after vaccination:9
Submitted: 1995-05-01
   Days after onset:11
Entered: 1995-05-10
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51030 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4G51030 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714C / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-04-20
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH95054

Write-up: parents deny any reactions following vax administration; no signs of fever, irritability or neurologic problems; died 20APR95 w/preliminary dx of SIDS;


VAERS ID: 75061 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1995-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0834R / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

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: No relevant data;
CDC Split Type: WAES94041158

Write-up: pt recv vax in winter of 1989 & 1 day later died; mail requesting f/u fr reporter was returned marked "moved-left no address-unable to forward-return to sender".


VAERS ID: 74126 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: California  
Vaccinated:1994-07-06
Onset:1994-08-10
   Days after vaccination:35
Submitted: 1995-05-11
   Days after onset:274
Entered: 1995-05-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 135932 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Hepatic neoplasm malignant, Neoplasm
SMQs:, Liver malignant tumours (narrow), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-01-01
   Days after onset: 144
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 125 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Septra
Current Illness: runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Biopsy; UA; ultra sound-CAT scan-MRI-Blood test-CBC-GFR
CDC Split Type:

Write-up: devel Hepatoblastoma (liver cancer); dx by biopsy on 17AUG94, condition present 30-45 days a/biopsy; 42 days a/biopsy was vaccinated; recv 5 rounds of chemotherapy & died 1JAN95;


VAERS ID: 74166 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Indiana  
Vaccinated:1995-05-03
Onset:1995-05-04
   Days after vaccination:1
Submitted: 1995-05-15
   Days after onset:11
Entered: 1995-05-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC Split Type: WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


VAERS ID: 74208 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Illinois  
Vaccinated:1995-05-05
Onset:0000-00-00
Submitted: 1995-05-18
Entered: 1995-05-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 394956 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1649A2 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386944 / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-07
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:

Write-up: NONE reported by family; death w/in 48 hr of vax administration;


VAERS ID: 74254 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1995-05-15
Onset:1995-05-15
   Days after vaccination:0
Submitted: 1995-05-18
   Days after onset:3
Entered: 1995-05-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51013 / UNK RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1297A / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384939 / UNK MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-16
   Days after onset: 1
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:
Current Illness: NONE
Preexisting Conditions: 37 wks gestation, birth weight 5lbs 7 oz; dextrocardia by chest x-rays & no murmurs;
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL950061

Write-up: fever the noc following vax but temp not measured; reported not feeding much; mom woke @ noon finding baby unresponsive, no resp, lips & feet blue;


VAERS ID: 74342 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: California  
Vaccinated:1995-05-05
Onset:1995-05-05
   Days after vaccination:0
Submitted: 1995-05-23
   Days after onset:18
Entered: 1995-05-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 390955 / 2 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1308A2 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0713H / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Brain oedema, Bronchiolitis, Bronchitis, Lung disorder, Pneumonia
SMQs:, Interstitial lung disease (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-08
   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: sickle trait
Allergies:
Diagnostic Lab Data: CBC - complete blood count;
CDC Split Type:

Write-up: pt recv vax; found expired in the am 3 days p/ vax;


VAERS ID: 74456 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:1994-12-09
Onset:1994-12-10
   Days after vaccination:1
Submitted: 1995-05-01
   Days after onset:141
Entered: 1995-06-01
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 378977 / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Cardiac failure, Dyspnoea, Injection site oedema, Injection site pain, Myocardial infarction
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-11
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: past EKG 1mo a/shots WNL & heart problem
Preexisting Conditions: hx kidney CA-1980; gets yearly checks; takes no prescription meds; alka seltzer plus OTC; coronary artery disease for 2 years; hypertension for 5 years;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI95039

Write-up: pt c/o lt arm swelling @ inj site extending to elbow; pt took a shower & applied heat; swelling painful & inc; difficult breathing; @ ER pt was resuscitated but pronounced dead of heart failure;


VAERS ID: 74634 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-05-10
Onset:1995-05-17
   Days after vaccination:7
Submitted: 1995-06-02
   Days after onset:16
Entered: 1995-06-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 394955 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-17
   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: none
Preexisting Conditions: bronchiolitis march 1995; varicella apr95;
Allergies:
Diagnostic Lab Data: autopsy performed - pending;
CDC Split Type:

Write-up: pt recv vax;found in car asystolic & apneic on 17may95; was rushed to hosp p/ attempted resuscitation by paramedics;


VAERS ID: 74788 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1995-05-05
Onset:1995-05-09
   Days after vaccination:4
Submitted: 1995-06-06
   Days after onset:28
Entered: 1995-06-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP291 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715L / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Not known~ ()~~~In patient
Other Medications: Cisapride
Current Illness: Gastroesophageal reflux
Preexisting Conditions: Gastroesophageal reflux; prematurity
Allergies:
Diagnostic Lab Data: autopsy pending-results neg
CDC Split Type:

Write-up: pt found limp p/nursing; attempted resuscitation by EMTs & hosp ER unsuccessful; ME autopsy


VAERS ID: 74820 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:1995-05-23
Onset:1995-05-25
   Days after vaccination:2
Submitted: 1995-06-02
   Days after onset:8
Entered: 1995-06-13
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 394954 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1651B2 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715C / 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: 1995-05-25
   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: Tobramycin eye drops; Mometasone cream
Current Illness: docrocystitis eczema;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: found dead in bed 530PM 25MAY95;


VAERS ID: 75164 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1995-04-07
Onset:1995-04-22
   Days after vaccination:15
Submitted: 1995-04-25
   Days after onset:3
Entered: 1995-06-19
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384977 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1062A / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714H / 1 MO / PO

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: 1995-04-22
   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: unk
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: TX95083

Write-up: SIDS death


VAERS ID: 75176 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1995-05-03
Onset:1995-05-06
   Days after vaccination:3
Submitted: 1995-05-08
   Days after onset:2
Entered: 1995-06-19
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 374964 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1405A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388925 / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX95095

Write-up: pt was taken to hosp 6MAY95 DOA;


VAERS ID: 75197 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1995-06-08
Onset:1995-06-14
   Days after vaccination:6
Submitted: 1995-06-15
   Days after onset:1
Entered: 1995-06-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 387910 / 2 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1596B2 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 426344 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated, Haemorrhage, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: h/o gastroesophageal reflux
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 14JUN95 pt was found to be not breathing by the mother, rushed to local hosp by paramedics & found to be dead on arrival


VAERS ID: 75198 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Indiana  
Vaccinated:1994-11-08
Onset:1994-11-14
   Days after vaccination:6
Submitted: 1995-06-09
   Days after onset:206
Entered: 1995-06-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1223ASB / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER J0870 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380950 / 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: 1994-11-14
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 14NOV94 SIDS following immunizations 8NOV94


VAERS ID: 75377 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:1995-03-27
Onset:1995-04-12
   Days after vaccination:16
Submitted: 1995-06-21
   Days after onset:70
Entered: 1995-06-26
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1653A2 / 2 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Back pain, Cardiac failure, Chills, Hepatic failure, Insomnia, Neck pain, Pain, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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), Cardiomyopathy (broad), Chronic kidney disease (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-04-13
   Days after onset: 1
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: allergy Keflex, Narcolepsy, pacemaker, sleep apnea; no hx of allergy to bread, pickles, tuna
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950049591

Write-up: pt recv vax 27MAR95 1115AM & reported lt arm pain radiating into neck called MD; backache, neck ache, diff sleeping & feeling hot alternating w/cold;adm to hosp, to ICU;liver, renal & cardiac failure; pt died 13APR95


VAERS ID: 75454 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: South Carolina  
Vaccinated:1994-12-16
Onset:0000-00-00
Submitted: 1995-01-17
Entered: 1995-06-27
   Days after submission:160
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 374965 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 376941 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-16
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: NA
Preexisting Conditions: 31 wks gestation/premature birth
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC95044

Write-up: death 16JAN95-not attributed to vaccine; death certificate states pt exp multisystem organ failures & acute viral infection


VAERS ID: 75498 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: New York  
Vaccinated:1995-02-10
Onset:1995-02-21
   Days after vaccination:11
Submitted: 1995-06-26
   Days after onset:124
Entered: 1995-06-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0968A / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Anaemia, Bone marrow depression, Encephalitis, Leukopenia, Mouth ulceration, Pyrexia, Thrombocytopenia, Visual disturbance
SMQs:, Severe cutaneous adverse reactions (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PPD from lederle given 10FEB95
Current Illness: Roseola?
Preexisting Conditions: innocent heart neg; dubonitz synd, SGA/IUGR;
Allergies:
Diagnostic Lab Data: CBC: WBC =.8; Het=25; Plt=22k; PT 13; PTT 37;
CDC Split Type:

Write-up: pt recv vax; T 105.4; encephalitis, bone marrow suppression, visual disturbance, mouth sores;


VAERS ID: 75507 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arkansas  
Vaccinated:1995-06-21
Onset:1995-06-21
   Days after vaccination:0
Submitted: 1995-06-23
   Days after onset:2
Entered: 1995-06-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61024 / 2 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1411A / 3 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4E61024 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388929 / 2 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Dysphagia, Dyspnoea, Miosis, Respiratory disorder, Sudden infant death syndrome, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Dehydration (broad)

Life Threatening? Yes
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: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays neg for pathology;
CDC Split Type: AR9544

Write-up: pt recv vax;@ home mom reports difficulty breathing;to er;full arrest;CPR adm;resuscitated;P=159;felt warm;;thought to be chocking;pupils small; pt''s VS full;pt intubated;epi given;pt died,suspected SIDS;


VAERS ID: 75559 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Alaska  
Vaccinated:1994-10-26
Onset:0000-00-00
Submitted: 1994-05-19
Entered: 1995-07-03
   Days after submission:410
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51023 / UNK RA / -

Administered by: Public       Purchased by: Public
Symptoms: Chest pain, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AK95021

Write-up: pt expired approx 2 1/2wks p/vax; pt died of MI; had chest pain approx 1 wk prior to MI; coded & expired;


VAERS ID: 75560 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Alaska  
Vaccinated:1994-11-16
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1995-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51023 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-23
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: end-stage liver disease, COPD, on 02
Allergies:
Diagnostic Lab Data:
CDC Split Type: AK95022

Write-up: pt expired approx 1 wk p/vax given; clinic reports pt''s death was expected; pt was in end-stage liver disease, COPD, on 02


VAERS ID: 75867 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-05-19
Onset:1995-05-21
   Days after vaccination:2
Submitted: 1995-06-23
   Days after onset:33
Entered: 1995-07-13
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), 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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC Split Type: PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


VAERS ID: 75931 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Oklahoma  
Vaccinated:1995-06-19
Onset:1995-06-22
   Days after vaccination:3
Submitted: 1995-06-26
   Days after onset:4
Entered: 1995-07-17
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 390952 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388919 / 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: 1995-06-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: OK9528

Write-up: pt recv vax;examiner''s ofc called 26jun95 to report that pt was found dead in crib 22jun95; infant had no sx of illness prior to death; no sx of illness prior to death; no sz activity; no fever;


VAERS ID: 75940 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:1995-06-19
Onset:0000-00-00
Submitted: 1995-07-03
Entered: 1995-07-17
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B6114 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B6114 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 717B1 / 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: 1995-06-20
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: failure to thrive
Allergies:
Diagnostic Lab Data: autopsy revealed SIDS;
CDC Split Type:

Write-up: pt recv vax; infant found lifeless in crib on the am following the day of vax; no premonitory signs or sx reported;autopsy revealed SIDS;


VAERS ID: 75989 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1995-06-22
Onset:1995-06-24
   Days after vaccination:2
Submitted: 1995-06-26
   Days after onset:2
Entered: 1995-07-19
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61015 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1329A2 / 1 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4E61015 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0721E / 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: 1995-06-24
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden death 24JUN95 2 days p/vax;


VAERS ID: 75990 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1995-06-22
Onset:1995-06-23
   Days after vaccination:1
Submitted: 1995-07-14
   Days after onset:21
Entered: 1995-07-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4C61144 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265CJ / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 07174 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Brain oedema, Oedema, Petechiae, Pulmonary haemorrhage, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-06-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: apneic episode 24 hr p/vax; to ER by 911 code;


VAERS ID: 76018 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New Jersey  
Vaccinated:1995-06-15
Onset:1995-06-26
   Days after vaccination:11
Submitted: 1995-07-10
   Days after onset:14
Entered: 1995-07-20
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1657B2 / 2 LL / -

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: 1995-06-24
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was reported to have died @ hosp; ? sids


VAERS ID: 76065 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1995-07-17
Onset:1995-07-18
   Days after vaccination:1
Submitted: 1995-07-20
   Days after onset:2
Entered: 1995-07-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61158 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0703A / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61158 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 392929 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Cardiac arrest, Dyspnoea, Pallor, Sudden infant death syndrome
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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-07-18
   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: none
Current Illness: none
Preexisting Conditions: mild aortic stenosis, mild coarctation of aorta
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: pt recv vax; sudden death; pale, grunting at home; expired w/in mins p/ moaning; arrived to er in asystole;


VAERS ID: 76307 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1995-04-20
Onset:0000-00-00
Submitted: 1995-07-05
Entered: 1995-08-01
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384977 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1164A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714H / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Cyanosis, Haemorrhage, Hypothermia, Meningitis, Petechiae
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious meningitis (narrow), Accidents and injuries (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-04-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG-idioventricular
CDC Split Type: TX95134

Write-up: pt recv vax;leg looked like it was baked per mom;amb called for poss CPR arrived CPR in progress;mom woke up found pt under the pillow, unresponsive;pupils fixed dilated, skin warm w/cyanosis;pt lifeless @ home dx unexplained death of pt


VAERS ID: 76365 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1995-06-13
Onset:1995-06-24
   Days after vaccination:11
Submitted: 1995-06-28
   Days after onset:4
Entered: 1995-08-03
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372933 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718L / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Oedema, Petechiae, Pulmonary oedema, Skin nodule, Stupor, Sudden infant death syndrome, Vasodilatation
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: GA95101

Write-up: pt found dead at home 24JUN95;


VAERS ID: 76368 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1995-05-03
Onset:0000-00-00
Submitted: 1995-06-09
Entered: 1995-08-03
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369909 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Congenital anomaly, Convulsion, Hypotonia, Necrosis, Pneumonia, Pulmonary haemorrhage, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (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), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: oral ATB
Current Illness: afeb URI
Preexisting Conditions: @home birth to 15yo mom-microcephaly w/brain atrophy
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA95108

Write-up: No indication that this was an adverse rxn to, or result of immun; COD bronchopneumonia;


VAERS ID: 76579 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1995-06-02
Onset:1995-06-16
   Days after vaccination:14
Submitted: 1995-08-02
   Days after onset:47
Entered: 1995-08-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0412B / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Dehydration, Emphysema, Gastrointestinal haemorrhage, Hypotension, Immune system disorder, Pneumonia, Pneumothorax, Skin necrosis
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal haemorrhage (narrow), Extravasation events (injections, infusions and implants) (broad), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: none
Preexisting Conditions: iron deficiency anemia
Allergies:
Diagnostic Lab Data: 1JUL-LDH1500;19JUL-HGB10.4,SGOT-400,SGPT-140,WBC-4900;JUL95-CXRinterstit pneum;SKIN BX-Necrotic Skin;EBV-IGM+;bronchoalveolar lavage-pneumocystis carinii.
CDC Split Type: WAES95070987

Write-up: recv vax,exp dec appetite;16JUN devel rash on extremities,fever,anemia;12JUL9cough/pneumonia;hosp w/resp distress-intubated,dx w/GianottiCrostiSynd,immune system defect,pneumocystis carinii pneumonia,early EBV infect,expired 24AUG95,COD-Acu


VAERS ID: 76529 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Indiana  
Vaccinated:1995-08-03
Onset:1995-08-03
   Days after vaccination:0
Submitted: 1995-08-04
   Days after onset:1
Entered: 1995-08-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1657A2 / 2 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Haemorrhage, Petechiae, Pyrexia, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), 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), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-08-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recvd hep B vax lot# 1595B9 23JUN95;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: coroners exam
CDC Split Type:

Write-up: pt found by parents this morning p/vax apneic & cyanotic; paramedics & ER MD unable to resuscitate;


VAERS ID: 76587 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Florida  
Vaccinated:1995-03-08
Onset:1995-04-05
   Days after vaccination:28
Submitted: 1995-08-08
   Days after onset:125
Entered: 1995-08-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0455W / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0735P / 2 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Hepatomegaly, Neoplasm malignant, Pain, Pyrexia, Splenomegaly, Vomiting, Weight decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-06-19
   Days after onset: 75
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: lab work done, positive for strep
CDC Split Type:

Write-up: pt recv vax;about 4-5 wk p/ vax pt c/o pain in her rt side,not better,hosp,dx w/ cancer;mom thinks vax triggered cancer;c/o pharyngitis,v,dec appetite;significant weight dec;pain abd;T 99.3;back pain;pt died from renal cell carcinoma;


VAERS ID: 76675 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1995-08-15
Entered: 1995-08-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

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: No relevant data;
CDC Split Type: WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


VAERS ID: 76677 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Alabama  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1995-08-03
Entered: 1995-08-21
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

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: 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: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895216016L

Write-up: a mom reports that 1 yr ago, baby died 1 day p/receiving a DTP vax; the COD was reported to be SIDS;


VAERS ID: 76680 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Missouri  
Vaccinated:1993-12-03
Onset:1993-12-29
   Days after vaccination:26
Submitted: 1995-08-17
   Days after onset:595
Entered: 1995-08-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358919 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 359949 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Vomiting
SMQs:, Acute pancreatitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-29
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: COD endocardial fibrolastosis
CDC Split Type:

Write-up: pt had morning feeding milk 830AM & vomited;pt given thawed milk but vomited again;pt given sterilized water w/o success- MD called who recommended pedialyte q 15 mins x 6hr;pt refused pedialyte;pt stop breathing en-route to ER


VAERS ID: 76789 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Arizona  
Vaccinated:1995-08-17
Onset:1995-08-18
   Days after vaccination:1
Submitted: 1995-08-21
   Days after onset:3
Entered: 1995-08-23
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428035 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1286A / 2 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0723E / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-08-18
   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: na
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: pt recv vax;awoke in early am 18aug;was fed & put back to bed;when mom awoke 1 hr later, pt found unresponsive;


VAERS ID: 76894 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1995-08-28
Onset:1995-08-28
   Days after vaccination:0
Submitted: 1995-08-28
   Days after onset:0
Entered: 1995-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 394957 / 2 RL / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 390926 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Pyrexia, Sudden infant death syndrome
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), Acute central respiratory depression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-08-28
   Days after onset: 0
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: NONE
Current Illness: NONE
Preexisting Conditions: prematurity @ 28wks
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt exp cardiac arrest about 2 1/2 hr p/vax;was sleeping @ time;t99.0;?SIDS


VAERS ID: 77309 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Colorado  
Vaccinated:1995-08-10
Onset:1995-08-13
   Days after vaccination:3
Submitted: 1995-08-15
   Days after onset:2
Entered: 1995-09-13
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426117 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0704A / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0723D / 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: 1995-08-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO95045

Write-up: coroner report SIDS; mom gave APAP p/vax


VAERS ID: 77502 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1995-08-16
Onset:1995-08-17
   Days after vaccination:1
Submitted: 1995-08-18
   Days after onset:1
Entered: 1995-09-15
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427838 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1288A / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 427180 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Apnoea, Atelectasis, Cardiac arrest, Haemorrhage, Petechiae, Pyrexia, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-08-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: healthy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895235001L

Write-up: pt recv vax; died next day; COD unk; autopsy pending; MFR has been notified of adverse event;


VAERS ID: 77511 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1995-04-26
Onset:1995-05-21
   Days after vaccination:25
Submitted: 1995-05-26
   Days after onset:5
Entered: 1995-09-15
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426117 / 2 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 1719D / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest, Hepatocellular damage, Pulmonary haemorrhage, Sudden infant death syndrome, Vasodilatation, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-21
   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: given Septra 26APR95
Current Illness: runny nose/ear infect;bronchitis/pneumon
Preexisting Conditions: hx of bronchitis or pneumonia over past few days
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR9513

Write-up: pt put to bed on tummy-mom found pt had vomited & was dead;EMT tried to resuscitate;15MAR95 chickenpox;hyperemia of lung w/focal alveolar hemorrhage;autopsy findings are consistent w/SIDS;21MAY pt was irritable later found in bed dead


VAERS ID: 77513 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1990-09-19
Onset:0000-00-00
Submitted: 1990-11-21
Entered: 1995-09-15
   Days after submission:1758
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259965 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0607F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-09
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:
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: SIDS death 9COT90
CDC Split Type: OR9444

Write-up: pt recv vax 19SEP90 & was unresponsive by mom p/having been put down for a morning nap p/feeding; resuscitative attempts were unsuccessful; COD attributed to SIDS; manner of death is natural


VAERS ID: 77561 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Minnesota  
Vaccinated:1995-09-08
Onset:1995-09-09
   Days after vaccination:1
Submitted: 1995-09-11
   Days after onset:2
Entered: 1995-09-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426148 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1740A4 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 07525H / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mom had rxn to tetanus~ ()~~~In patient
Other Medications: apap
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; fussy at noc; died next day;


VAERS ID: 77580 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1995-08-29
Onset:1995-08-30
   Days after vaccination:1
Submitted: 1995-08-31
   Days after onset:1
Entered: 1995-09-22
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1668B2 / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-08-30
   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: pt recvd Engerix-B vax 25JUL95
Current Illness:
Preexisting Conditions: undescended testicle; NKA;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950086371

Write-up: pt recv vax 29AUG95 & died 12-15 hrs later; reporting nurse indicated that the death was most probably attributable to sudden infant death synd (SIDS);


VAERS ID: 77582 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1995-08-30
Entered: 1995-09-22
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), 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: pt recvd HEP B vax OCT1994
Current Illness:
Preexisting Conditions: premature
Allergies:
Diagnostic Lab Data: HBSAN positive
CDC Split Type: 950085841

Write-up: several days p/vax pt reportedly died d/t resp complications; blood test on autopsy indicated a pos hep B surface antigen; attempting to obtain further details;


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