National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Found 8,467 cases where Patient Died

Case Details

This is page 12 out of 85

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85   next


VAERS ID: 87119 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Indiana  
Vaccinated:1996-06-01
Onset:1996-06-02
   Days after vaccination:1
Submitted: 1996-06-11
   Days after onset:9
Entered: 1996-06-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 433565 / 3 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Apnoea, Convulsion, Diarrhoea, Leukopenia, Pyrexia, Screaming, Somnolence
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (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), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Nistatin-oral thrush
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC 1000;spinal tap;other labs unavail
CDC Split Type:

Write-up: pt running temp 104.2, 101, 102.8; irritable, not eating well;crying all noc, diarrhea, lethargic, resp arrest & sz-pt died;


VAERS ID: 87121 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New York  
Vaccinated:1996-02-28
Onset:1996-03-06
   Days after vaccination:7
Submitted: 1996-06-11
   Days after onset:96
Entered: 1996-06-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432656 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 398929 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Screaming, Sepsis, Shock, Stupor
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), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1996-03-07
   Days after onset: 1
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:
Current Illness: NA
Preexisting Conditions: premature birth 32wk, poor prenatal car A''s + B''s
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 28FEB96 & on 6MAR96 pt presented to ofc for crying all noc;suddenly became nonresponsive & blue-CPR-intubation-to hosp shock & resp arrest;bilat adrenal hemorrhage on post


VAERS ID: 87206 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Maryland  
Vaccinated:1996-05-23
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432655 / 3 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1991A2 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0736L / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: 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: 1996-05-27
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD96015

Write-up: fever (high) x 2d;pt died 27MAY96


VAERS ID: 87231 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1996-01-10
Onset:1996-02-12
   Days after vaccination:33
Submitted: 1996-05-30
   Days after onset:107
Entered: 1996-06-24
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4C61144 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0788A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0726E / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Infection, Lung disorder, Pneumonia, Pulmonary oedema, Pyrexia, Sudden infant death syndrome, Vascular anomaly
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-02-12
   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: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA96067

Write-up: 11FEB96 according to pt aunt pt had an illness w/cold-like sx, went to ER, t104, d/c p/4hr;couldn''t breath well, nose stopped up;12FEB96 fever down to 101;6AM nl feeding, 11AM, found dead;


VAERS ID: 87290 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-11-30
Onset:1994-12-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1996-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51020 / 3 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0793A / 3 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0702D / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-04
   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: Ceclor
Current Illness: 16NOV94 ear infect, bronchitisq
Preexisting Conditions: hx pylonephritis 23SEP94-saw a urologist/failure to thrive 2JUN96
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94041

Write-up: SIDS-4DEC94


VAERS ID: 87291 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1995-10-04
Onset:1995-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426150 / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1289A / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0723B / 1 - / -

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: 1995-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt recvd Hep B vax by MSD given 11JUL95
Current Illness:
Preexisting Conditions: NKA-cleft lip
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH95038

Write-up: SIDS-5OCT95


VAERS ID: 87397 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1988-07-26
Onset:1988-08-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1996-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (NO BRAND NAME) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Alkalosis, Apnoea, Cardiac arrest, Encephalitis, Hepatitis, Hyponatraemia, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatitis, non-infectious (narrow), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1988-09-15
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1wk p/vax pt exp loss of motor coordination & other neuro sequelae, w/high spiking fevers;pt was hosp on 27AUG88 dx w/encephalitis, hepatitis, hypochloremic metabolic alkalosis, acute resp failure, thrombocytopenia, anemia


VAERS ID: 87427 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Carolina  
Vaccinated:1996-06-06
Onset:1996-06-06
   Days after vaccination:0
Submitted: 1996-06-17
   Days after onset:11
Entered: 1996-07-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61008 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1353A9 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61008 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 430179 / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Chills, Cyanosis, Infection, Malaise, Petechiae, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-06-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP, ointment for rash/face
Current Illness: NONE
Preexisting Conditions: +hep C test @ hosp p/birth
Allergies:
Diagnostic Lab Data: +hepatitis C per test @ hosp p/birth;autopsy reports SIDS on death certificate;
CDC Split Type: SC96043

Write-up: pt recv vax 6JUN96 & pt seemed healthy & happy (smiled a lot) AM of vax;mom called nurse 10JUN96 reporting pt was listless-no energy p/vax;no fever;mom holding pt in evening, mom fell asleep & awakened to find pt cold & deceased & blue;


VAERS ID: 87429 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1996-02-06
Onset:1996-02-16
   Days after vaccination:10
Submitted: 1996-06-06
   Days after onset:110
Entered: 1996-07-01
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386987 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0729M / 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: 1996-02-16
   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: GA96074

Write-up: pt recv vax 6FEB96 & deceased 16FEB96;SIDS


VAERS ID: 87501 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1996-06-27
Entered: 1996-07-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 433565 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 432060 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Petechiae, Rash, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-05-25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: amax
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; SIDS 19 days later;


VAERS ID: 87502 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Alabama  
Vaccinated:1996-06-24
Onset:1996-06-26
   Days after vaccination:2
Submitted: 1996-06-26
   Days after onset:0
Entered: 1996-07-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5F71109 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 6M61033 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 431772 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Ecchymosis, Gastrointestinal disorder, Lung disorder, Petechiae, Pulmonary oedema, Respiratory disorder, Skin discolouration, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-06-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax; died; probably SIDS;


VAERS ID: 87547 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-02-12
Onset:1996-02-19
   Days after vaccination:7
Submitted: 1996-06-24
   Days after onset:125
Entered: 1996-07-03
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5J61057 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5J61057 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0735K / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv Hep B vax lot# 1904A2 by SKB on 6NOV95
Current Illness:
Preexisting Conditions: cold-office visit 30DEC95
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, sleepy/tempora from MD office


VAERS ID: 87564 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1996-06-05
Entered: 1996-07-05
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other       Purchased by: Other
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: pt sibling devel tachycardia following Tetramune inj~ ()~~~In Sibling
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896163011L

Write-up: pt recv vax & subsequently died of SIDS


VAERS ID: 87648 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:1996-04-08
Onset:1996-04-14
   Days after vaccination:6
Submitted: 1996-07-01
   Days after onset:78
Entered: 1996-07-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432655 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 431988 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-04-14
   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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autposy was done at another institution;
CDC Split Type:

Write-up: pt recv vax; child found not breathing in morning; ambulance was ER and resuscitation was tried;


VAERS ID: 87649 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Oregon  
Vaccinated:1996-06-28
Onset:0000-00-00
Submitted: 1996-07-03
Entered: 1996-07-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1189B / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-06-30
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: candidas diaper rash 28jun96
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; infant demise on 30jun96


VAERS ID: 87849 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Alabama  
Vaccinated:1996-06-27
Onset:1996-06-28
   Days after vaccination:1
Submitted: 1996-07-10
   Days after onset:12
Entered: 1996-07-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432655 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1907A2 / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiovascular disorder, Lung disorder, Peripheral vascular disorder, Skin discolouration, Stupor, 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 (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-06-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: bilat club feet
Allergies:
Diagnostic Lab Data: findings consistent w/SIDS;blood gases were exceedingly poor w/a PH of 628, a PO2 of 39, PC02 greater than 100;K 8.8,calcium 10.9, BUN 7, CO2 7, creatininte 0.6, glucose 373;WBC count 16,000 w/18 polys, 75 lymphs, 7monos, hemoglobin 8.6
CDC Split Type:

Write-up: pt was found cold & unresponsive in crib @ daycare;paramedics noted pt to be mottled & cold;pt ventilated by bag to endotracheal tube;hosp stated no spontaneous HR & poor capillary refill;pupils fixed & dilated;no movement;consistent w/SIDS


VAERS ID: 87977 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Mississippi  
Vaccinated:1996-06-11
Onset:1996-06-13
   Days after vaccination:2
Submitted: 1996-07-10
   Days after onset:27
Entered: 1996-07-19
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 433564 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1666A9 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 433391 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Somnolence, Sudden infant death syndrome
SMQs:, Anticholinergic syndrome (broad), Dementia (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: 1996-06-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: otitis 17MAY96;resolved @ time of immunization
Allergies:
Diagnostic Lab Data: Autopsy-verbal report by coronor was grossly nl;no written report was given assumed to be SIDS;
CDC Split Type:

Write-up: pt seen for check-up on 11JUN96 4PM-had nl check-up x/diaper rash;pt recv vax & sent home in good condition;pt taken to babysitter appeared a little drowsy @ 8-9AM;thought to be sleeping when found dead;


VAERS ID: 88051 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Unknown  
Location: Massachusetts  
Vaccinated:1995-11-14
Onset:1995-12-19
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 1996-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP292 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010V / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 07228 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Cyst, Hydronephrosis, Petechiae, Pharyngitis, Respiratory disorder, Sudden infant death syndrome, Unevaluable event
SMQs:, Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Neonatal disorders (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-12-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH95040

Write-up: SIDS 19DEC95


VAERS ID: 88220 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1996-07-12
Onset:1996-07-13
   Days after vaccination:1
Submitted: 1996-07-24
   Days after onset:11
Entered: 1996-07-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434808 / UNK LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1405B / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 431996 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-13
   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: Levsin drops
Current Illness: hx colic, nl exam
Preexisting Conditions: preterm 33wk gestation, GC conjunctivitis treated
Allergies:
Diagnostic Lab Data: autopsy in progress, preliminary report SIDS-official report pending;
CDC Split Type:

Write-up: pt was taken to ER 13JUL96;


VAERS ID: 88426 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1996-06-27
Onset:1996-06-29
   Days after vaccination:2
Submitted: 1996-07-23
   Days after onset:24
Entered: 1996-08-02
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1626B / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5L71063 / UNK LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-02
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: the pt had a cardiac arrest


VAERS ID: 88833 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / 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: WAES96011310

Write-up: pt recv vax & pt died;the COD was unk;reporter felt that the pt death was r/t therapy w/pneumococcal vax;


VAERS ID: 88448 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-07-24
Onset:1996-07-26
   Days after vaccination:2
Submitted: 1996-07-26
   Days after onset:0
Entered: 1996-08-05
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5F71109 / 2 LL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 6M61035 / 3 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0744L / 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: 1996-07-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax on 24JUL-pronounced dead @ hosp on 26JUL;


VAERS ID: 88836 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:1996-01-09
Onset:1996-01-10
   Days after vaccination:1
Submitted: 1996-07-29
   Days after onset:200
Entered: 1996-08-08
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429964 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1607A9 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0724B / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Bronchiolitis, Bronchitis, Eosinophilia, Gastrointestinal disorder, Infection, Sudden infant death syndrome
SMQs:, Interstitial lung disease (narrow), Eosinophilic pneumonia (narrow), Neonatal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: poliviflor w/Fe
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: reported sudden death @ home w/in 24hr of vax;


VAERS ID: 88877 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1996-07-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0307D / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Ecchymosis, Injury, Muscle haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), 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), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-08-03
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:
CDC Split Type:

Write-up: pt had sudden cardiopulmonary arrest 3AUG96 while rollerblading;it was unclear whether his fall caused the death or whether another event triggered the fall;pt failed to respond to resuscitative efforts & died;


VAERS ID: 88999 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1996-08-06
Onset:1996-08-08
   Days after vaccination:2
Submitted: 1996-08-12
   Days after onset:4
Entered: 1996-08-15
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6H71044 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1404B / 2 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 6A71084 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 436956 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-08-08
   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: pt recv Hep B vax lot# 0175D by MSD on 7JUN96;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: body sent to medical examiner''s office
CDC Split Type:

Write-up: parents found baby in bed-not breathing;


VAERS ID: 89000 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Texas  
Vaccinated:1996-03-26
Onset:1996-03-27
   Days after vaccination:1
Submitted: 1996-03-28
   Days after onset:1
Entered: 1996-08-15
   Days after submission:139
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429968 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0769B / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0732H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Ecchymosis, Lung disorder, Petechiae, Skin discolouration, Skin disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-03-27
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: TX96097

Write-up: pt recv vax 26MAR96 between 11AM & 1145AM police called to notify clinic found dead on 27MAR96 in AM;autopsy revealed abrasion on face & thumb, lungs congested, pleural, thymic & epicardial petechiae, cerebral edema;final dx suffocation


VAERS ID: 89177 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Oklahoma  
Vaccinated:1996-07-25
Onset:1996-07-26
   Days after vaccination:1
Submitted: 1996-08-06
   Days after onset:11
Entered: 1996-08-19
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1406B / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 433399 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Meningitis, Sudden infant death syndrome, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: viral meningitis 1mo prior
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9623

Write-up: autopsy pending will send when get it;


VAERS ID: 89358 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Indiana  
Vaccinated:1996-08-09
Onset:1996-08-12
   Days after vaccination:3
Submitted: 1996-08-26
   Days after onset:14
Entered: 1996-08-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5L61174 / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 5561069 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6663

Write-up: pt recv vax & later on died;pathologist feel that crib death, but wants to report it;reporter doubts this is r/t vax & feels it is SIDS;


VAERS ID: 89893 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Massachusetts  
Vaccinated:1996-09-10
Onset:1996-09-11
   Days after vaccination:1
Submitted: 1996-09-11
   Days after onset:0
Entered: 1996-09-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP295 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt found cold, rigid & lifeless @ 620AM pronounced dead @ 635AM;


VAERS ID: 89957 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Arizona  
Vaccinated:1996-09-09
Onset:1996-09-09
   Days after vaccination:0
Submitted: 1996-09-11
   Days after onset:2
Entered: 1996-09-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt dead-autopsy inconclusive @ this time;


VAERS ID: 90265 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:1996-09-18
Onset:1996-09-22
   Days after vaccination:4
Submitted: 1996-09-27
   Days after onset:5
Entered: 1996-09-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Respiratory failure (broad), 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: 1996-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6786

Write-up: death, flu-like sx 3 days p/shot;


VAERS ID: 90514 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Wisconsin  
Vaccinated:1996-05-09
Onset:1996-05-27
   Days after vaccination:18
Submitted: 1996-10-03
   Days after onset:129
Entered: 1996-10-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432654 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1742A2 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0729K / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Delirium, Endocrine disorder, Hepatocellular damage, Petechiae, Pneumonia, Pulmonary oedema, Renal impairment, Sudden infant death syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-05-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none known
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; died of SIDS on 27may96;


VAERS ID: 90518 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Texas  
Vaccinated:1996-07-10
Onset:1996-07-10
   Days after vaccination:0
Submitted: 1996-07-16
   Days after onset:6
Entered: 1996-10-07
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0781300 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1992A2 / 3 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0781300 / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0739H / 3 MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Injury
SMQs:, Acute central respiratory depression (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: pending
CDC Split Type: TX96114

Write-up: pt recv vax; died later on same day; autopsy report and investigation pending; COD: smothering due to obstruction of face by plastic bag;


VAERS ID: 90623 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1996-10-02
Onset:1996-10-03
   Days after vaccination:1
Submitted: 1996-10-03
   Days after onset:0
Entered: 1996-10-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5E71074 / 1 - / IM L
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0640D / 2 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0717K / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Epistaxis, Salivary hypersecretion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: 1996-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: FEr-IN-SOL
Current Illness: NONE
Preexisting Conditions: prematurity (36 wk gestation);
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt fretful @ 7AM morning following vax, no fever noted;fed & put back to bed discovered by mom 10AM in bassinet lifeless, lying prone w/face in pool of saliva & blood


VAERS ID: 91219 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1996-07-10
Onset:1996-08-20
   Days after vaccination:41
Submitted: 1996-10-04
   Days after onset:45
Entered: 1996-10-25
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429966 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0735F / 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: 1996-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: mom states possible neuro porblems spottled during pregnancy-possibility that spine was not forming correctly;delivered @ hosp in case there were problems;nothing evident @ birth
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH96137

Write-up: parents deny any rxn following vax;no signs of fever, irritability or neurologic problems;died suddenly @ 12:49PM on 20AUG96;COD SIDS:


VAERS ID: 91424 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: Maryland  
Vaccinated:1996-10-08
Onset:1996-10-09
   Days after vaccination:1
Submitted: 1996-10-23
   Days after onset:14
Entered: 1996-10-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432654 / UNK LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 432000 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE/APAP?
Current Illness: NONE
Preexisting Conditions: congenital malformatia rt hand + rt lower leg;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD96013

Write-up: pt recv vax 2PM 8OCT96 & pt expired 5AM on 9OCT96;pathology negative per Medical Examiner presumed SIDS death;


VAERS ID: 91425 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1996-09-05
Onset:1996-09-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 1996-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0165D / 1 LL / IM

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: 1996-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE-sl jaundice
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH96025

Write-up: SIDS


VAERS ID: 91426 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1996-10-09
Onset:1996-10-12
   Days after vaccination:3
Submitted: 1996-10-25
   Days after onset:13
Entered: 1996-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434814 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2035A2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0744C / 1 MO / PO

Administered by: Private       Purchased by: Other
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: 1996-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: upper resp infect
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died 3 days p/vax;DTP/HIB vax w/OPV;


VAERS ID: 91427 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Illinois  
Vaccinated:1996-09-20
Onset:1996-09-28
   Days after vaccination:8
Submitted: 1996-10-23
   Days after onset:25
Entered: 1996-10-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 435909 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005LP / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-28
   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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autospy 28SEP or 29SEP;
CDC Split Type:

Write-up: pt found dead in bed autopsy by coroner negative;case signed as SIDS;vax given 20SEP96 w/routine physical;


VAERS ID: 91441 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-10-28
   Days after vaccination:0
Submitted: 1996-10-28
   Days after onset:0
Entered: 1996-11-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968202 / UNK RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Dizziness, Dyspnoea, Hyperhidrosis, Hypoxia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-28
   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: HTN
Allergies:
Diagnostic Lab Data: EKG-nl sinus thythm-nl ECG;
CDC Split Type:

Write-up: pt became diaphoretic, lightheaded, dizzy w/soreness in joints, sl heaviness in chest & SOB relieved w/02, ntg, IV NS;


VAERS ID: 91557 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: California  
Vaccinated:1994-12-21
Onset:1994-12-21
   Days after vaccination:0
Submitted: 1994-12-21
   Days after onset:0
Entered: 1996-11-04
   Days after submission:684
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 153B2 / UNK - / -

Administered by: Private       Purchased by: Public
Symptoms: Coma, Sudden infant death syndrome
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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: 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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA960107

Write-up: pt was given vax @ approx 1PM & died @ approx 8PM:pt went into coma in afternoon & was rushed to hosp;


VAERS ID: 91623 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1996-10-16
Onset:1996-10-18
   Days after vaccination:2
Submitted: 1996-10-24
   Days after onset:6
Entered: 1996-11-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00986P / 1 - / IM A

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1996-10-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC Split Type: 0010150960037

Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;pt died on 19OCT96;reporter states pt health had been


VAERS ID: 91791 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:1996-10-15
Onset:1996-10-17
   Days after vaccination:2
Submitted: 1996-10-22
   Days after onset:5
Entered: 1996-11-08
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-17
   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: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


VAERS ID: 91917 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Florida  
Vaccinated:1996-09-12
Onset:1996-09-16
   Days after vaccination:4
Submitted: 1996-11-08
   Days after onset:53
Entered: 1996-11-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Bone disorder, Cerebral haemorrhage, Delirium, Haemorrhage, Infection, Laboratory test abnormal, Subarachnoid haemorrhage, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

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:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SEP96 CT scan abnormalities;platelet count low;
CDC Split Type: WAES96102756

Write-up: pt recv vax 12SEP96 & 16SEP96 pt was adm to ICU w/a low platelet count;CT scan revealed abnormalities;pt began bleeding from mouth, 18SEP96 & brain dead;cause of death was cerebral hemorrhage;MD unsure if events r/t vax;


VAERS ID: 92053 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: Georgia  
Vaccinated:1996-07-24
Onset:1996-07-25
   Days after vaccination:1
Submitted: 1996-09-13
   Days after onset:50
Entered: 1996-11-18
   Days after submission:66
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434808 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0740B / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Shock, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (narrow), 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), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP cold medicine
Current Illness: mom states pt had a cold & gas
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: repeat PKU 24JUL96;
CDC Split Type: GA96133

Write-up: mom states pt had no rxn;COD circulatory collapse-SIDS;


VAERS ID: 92054 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:1996-11-05
Onset:1996-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00276P / UNK - / A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 92082 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1996-09-28
Onset:1996-10-04
   Days after vaccination:6
Submitted: 1996-11-06
   Days after onset:33
Entered: 1996-11-19
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438090 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0118B / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0748M / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: 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: 1996-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy DONE
CDC Split Type: IL960107

Write-up: sudden infant death synd;


VAERS ID: 92083 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Illinois  
Vaccinated:1996-09-17
Onset:1996-09-23
   Days after vaccination:6
Submitted: 1996-11-06
   Days after onset:44
Entered: 1996-11-19
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0118B / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-23
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy done-revealed bronchopneumonia as cause of death;
CDC Split Type: IL960106

Write-up: sudden infant death synd;


VAERS ID: 92136 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Kansas  
Vaccinated:1996-11-05
Onset:1996-11-05
   Days after vaccination:0
Submitted: 1996-11-11
   Days after onset:6
Entered: 1996-11-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00276P / 1 - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of heart disease?NKDA/no allergy to eggs;not taking coumadin/prev recv flu vax w/o rxn;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 0010150960083

Write-up: pt recv vax 5NOV96 & that evening pt died;pt had a hx of heart disease;pt was not allergic to eggs & had prev recv the flu vax w/o rxn;pt was not taking Coumadin;responsible MD does not think the death was r/t vax;


VAERS ID: 92248 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: New Jersey  
Vaccinated:1996-11-07
Onset:1996-11-08
   Days after vaccination:1
Submitted: 1996-11-18
   Days after onset:10
Entered: 1996-11-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0469D / 1 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Salivary hypersecretion
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: sickle cell trait
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found foaming @ the mouth;died suddenly-autopsy results not available;


VAERS ID: 92306 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: Alabama  
Vaccinated:1996-11-18
Onset:1996-11-19
   Days after vaccination:1
Submitted: 1996-11-20
   Days after onset:1
Entered: 1996-11-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6K71127 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M270PA / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 438122 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil-albuterol
Current Illness: OM/bronchitis
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: found dead in crib-autopsy pending;


VAERS ID: 92462 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Indiana  
Vaccinated:1996-11-19
Onset:1996-11-19
   Days after vaccination:0
Submitted: 1996-11-25
   Days after onset:6
Entered: 1996-11-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438622 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 749M2 / 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: 1996-11-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: mom stated cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-results pending;
CDC Split Type:

Write-up: death-presumed SIDS @ this time;death occurred 1030PM;


VAERS ID: 92463 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Male  
Location: Arizona  
Vaccinated:1996-10-27
Onset:1996-10-31
   Days after vaccination:4
Submitted: 1996-11-01
   Days after onset:1
Entered: 1996-11-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


VAERS ID: 92464 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: Arizona  
Vaccinated:1996-10-23
Onset:1996-10-30
   Days after vaccination:7
Submitted: 1996-11-01
   Days after onset:2
Entered: 1996-11-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Peripheral vascular disorder, Pupillary disorder, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   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: unk
Current Illness: unk
Preexisting Conditions: TYPE II DIABETES, CHF,SCHIZOPHRENIA, UTI
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896309012L

Write-up: 1 of 2 pt from a long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following receipt of flu vax;


VAERS ID: 92503 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1996-11-05
Onset:1996-11-13
   Days after vaccination:8
Submitted: 1996-11-27
   Days after onset:14
Entered: 1996-12-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Coronary artery disease
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


VAERS ID: 92505 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1996-10-22
Onset:1996-10-29
   Days after vaccination:7
Submitted: 1996-11-22
   Days after onset:24
Entered: 1996-12-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00586P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Diarrhoea, Haematemesis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-17
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theophylline, Lanoxin, Lasix, Multiple vitamins, Synthroid, Maalox, Prevacid, Compazine, Propulsid, Capoten, Potassium, Lactulose;
Current Illness: unk
Preexisting Conditions: peptic ulcer disease, COPD, atrial fibrillation, hypothyroidism, pacemaker, mitral valve replacement;
Allergies:
Diagnostic Lab Data: emesis positive for occult blood
CDC Split Type: 0010150960057

Write-up: pt recv vax 22OCT96 & 29OCT96 exp n/v, vomiting blood, & diarrhea w/o fever;pt hosp & condition has been described as grave;pt has not yet recovered;


VAERS ID: 92612 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1996-10-21
Onset:1996-10-21
   Days after vaccination:0
Submitted: 1996-11-13
   Days after onset:23
Entered: 1996-12-09
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968175 / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1626B / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypertension, Myelitis, Paralysis, Quadriplegia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, hyperlipidemia, hypercholesterolemia and smoking 1.5 packs per day for 13 years
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896323001L

Write-up: pt recv vax & devel transverse myelitis, & was hosp, & is a quadriplegic;reporter was notified of this event as part of litigation proceedings;


VAERS ID: 92618 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Mississippi  
Vaccinated:1996-11-26
Onset:1996-11-27
   Days after vaccination:1
Submitted: 1996-12-04
   Days after onset:7
Entered: 1996-12-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438090 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 439864 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Brain oedema, Cerebral infarction, Congenital genitourinary abnormality, Hepatic function abnormal, Infection, Pneumonia, Spleen disorder
SMQs:, Liver related investigations, signs and symptoms (narrow), Ischaemic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (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: 1996-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Erythromycin/sulfisoxazole
Current Illness: NONE;OM resolved
Preexisting Conditions: OM;mild pulmonary valve stenosis;no allergies;
Allergies:
Diagnostic Lab Data: Negative blood, urine, CSF cult;nl serum chem;CT head sz w/cerebral infarctions-resp arrest-cerebral edema;autopsy pending;
CDC Split Type:

Write-up: prolonged sz activity w/bilat cerebral infarctions-resp arrest & cerebral edema w/in 24hr of vax;death w/in 36hr of vax;tx w/med;mechanical ventilation;


VAERS ID: 92619 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1996-10-11
Onset:1996-10-12
   Days after vaccination:1
Submitted: 1996-11-11
   Days after onset:30
Entered: 1996-12-09
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438090 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2061A2 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0739H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiac failure, Hepatocellular damage, Lung disorder, Petechiae, Renal impairment, Spleen disorder, Sudden infant death syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS96048

Write-up: infant died of SIDS;


VAERS ID: 92626 (history)  
Form: Version 1.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-09-26
Onset:1996-10-01
   Days after vaccination:5
Submitted: 1996-12-05
   Days after onset:65
Entered: 1996-12-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1656B / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Chronic myeloid leukaemia, Dermatitis bullous, Leukocytosis, Lymphadenopathy
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: serum cholesterol 109( pre-vaccine);WBC count 9400;varicella antibody negative (pre-vaccination);
CDC Split Type: WAES96111493

Write-up: pt recv vax & approx 2 wk p/vax pt devel a chickenpox rash w/21 lesions;1wk later devel enlarged lymph nodes;lab eval revealed WBC count 9400;dx w/acute myelogenous leukemia;pt hosp & placed on chemotherapy;PE prior to vax was nl;


VAERS ID: 92652 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-01
Onset:1996-11-02
   Days after vaccination:32
Submitted: 1996-11-28
   Days after onset:26
Entered: 1996-12-11
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Cardiac arrest, Guillain-Barre syndrome, Hypoxia, Quadriplegia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), 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 (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-17
   Days after onset: 15
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: inhaler for COPD (identity unk)
Current Illness:
Preexisting Conditions: COPD, Crohn''s disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: adm on 2NOV96 w/weakness, progressing to quadraparesis;GBS dx;required intubation & ventilation;tx w/immunoglobulin, & then plasamaphoresis w/no improvement;cardiac arrest on 17NOV96;could not be resuscitated;


VAERS ID: 92804 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:1996-10-16
Onset:1996-10-17
   Days after vaccination:1
Submitted: 1996-11-25
   Days after onset:39
Entered: 1996-12-13
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71212 / UNK - / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Guillain-Barre syndrome, Hypokinesia, Influenza, Myalgia, Neuropathy, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   Days after onset: 14
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:
CDC Split Type: CA960127

Write-up: pt started having flu-like sx day p/vax including fever, malaise, gen aching;seen in ER several days later exp peripheral neuropathy of arms & legs;unable to stand;hosp;dx GBS;severe autonomic collapse unable to resuscitate;pt died 31OCT96;


VAERS ID: 93234 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1996-11-07
Onset:1996-11-17
   Days after vaccination:10
Submitted: 1996-11-27
   Days after onset:10
Entered: 1996-12-26
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: cultures of blisters were pos for beta-hemolytic streptococcus type a
CDC Split Type: 896337007L

Write-up: approx 10 days after recv vax pt devel blisters on the hands & ankles. Pt hosp & tx w/ meds


VAERS ID: 93593 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Maryland  
Vaccinated:1996-12-16
Onset:1996-12-17
   Days after vaccination:1
Submitted: 1997-01-02
   Days after onset:16
Entered: 1997-01-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 439194 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 438118 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Hypoxia, Sudden infant death syndrome
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-17
   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: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was pound w/o vital signs, face down on couch, taken to hosp, full code given, no response. MD said SIDS or suffocation, waiting for "post," full report.


VAERS ID: 93595 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:1996-10-09
Onset:1996-10-15
   Days after vaccination:6
Submitted: 1997-01-02
   Days after onset:79
Entered: 1997-01-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71212 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many
Current Illness: endstage CHF
Preexisting Conditions: ASA; novocaine; CHF terminal
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 19oct96; pt died 15oct96, not necessarily related, pt had terminal CHF disease


VAERS ID: 93596 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1995-07-18
Onset:1995-07-25
   Days after vaccination:7
Submitted: 1997-01-02
   Days after onset:527
Entered: 1997-01-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 390955 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1407A / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 394915 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-07-25
   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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies:
Diagnostic Lab Data: autopsy c/ w sids
CDC Split Type:

Write-up: pt found unresponsive in crib. resuscitation unsuccessful.


VAERS ID: 93627 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1997-01-06
Onset:1997-01-07
   Days after vaccination:1
Submitted: 1997-01-07
   Days after onset:0
Entered: 1997-01-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441100 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2131AZ / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0749D / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: 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: 1997-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: resolving diaper rash
Preexisting Conditions: healthy child
Allergies:
Diagnostic Lab Data: RSV nasal culture pending
CDC Split Type:

Write-up: pt seen 06jan97 @ around 11:30 am for routine will child visit; recv routine vax; presented to Emergency dept 18 hr after vax w/ apparent SIDS


VAERS ID: 93695 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-12-14
   Days after vaccination:47
Submitted: 1997-01-02
   Days after onset:19
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00696P / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cough, Infection, Pneumonia, Pyrexia, Respiratory disorder, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, Cytotec, Voltaren, synthroid
Current Illness: NONE REPORTED
Preexisting Conditions: hx of hypothyroidism, pre renal azotemia, CVA (old) - lt hemiparesis, CHF, HTN, osteoarthritis, intermittent atrial fibrillation, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type: 0010150970006

Write-up: pt recv vax 28OCT96 & 14DEC96 pt devel a cough & rhinitis;symmetrel was prescribed; 2 days later 16DEC96 pt t103 & put on APAP & ATB;temp down to 99.8 w/in 4 hr;pt expired that day cause unk. The death certificate states aspiration.


VAERS ID: 93696 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-12-15
   Days after vaccination:48
Submitted: 1997-01-02
   Days after onset:18
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 00696P / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Coronary artery disease, Dementia, Hypertension, Infection, Lung disorder, Malaise, Pneumonia
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE REPORTED
Preexisting Conditions: hx of dementia, CAD, HTN, COPD, hiatal hernia, osteoarthritis, angina, hypokalemia
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150970007

Write-up: pt recv vax 28OCT96 & 15DC96 pt devel a cough, restlessness, malaise, anorexia & elevated temp of 102;APAP & symmetrel prescribed;2 days later 17DEC96 pt was afeb but cough worsened;pt on ATB following day 18DEC96 pt expired-cause unk;


VAERS ID: 93697 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-11-04
   Days after vaccination:7
Submitted: 1997-01-02
   Days after onset:59
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00696P / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anorexia, Cardiac arrest, Cough, Dementia, Malaise, Pneumonia, Pyrexia, Rhinitis
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), Dementia (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-23
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec, Antivert, Multivitamni, TUMS, Vitamin C
Current Illness: NONE
Preexisting Conditions: hx of dementia, postional vertigo, HTN, mild renal failure, multiple allergies;
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150970008

Write-up: pt recv vax 28OCT96 & 4NOV96 pt devel a cough & congestion & was treated w/med;pt devel t99.0, anorexia & malaise;5 days later 23DEC96 pt expired-cause unk;


VAERS ID: 93698 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-12-18
   Days after vaccination:51
Submitted: 1997-01-02
   Days after onset:15
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 00696P / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Cough, Hypotension, Infection, Pneumonia, Pyrexia, Rhinitis, Sepsis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, irritable bowel synd, legally blind, diverticulitis, anemia
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150970009

Write-up: pt recv vax 28OCT96 & 18DEC96 pt devel cough, congestion, elevated temp of 99.8, anorexia;2 days later 20DEC96 pt expired-cause unk;


VAERS ID: 93795 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arkansas  
Vaccinated:1996-01-12
Onset:1996-01-20
   Days after vaccination:8
Submitted: 1996-02-05
   Days after onset:16
Entered: 1997-01-15
   Days after submission:345
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428035 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1737A2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0730H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Pharyngitis, Rhinitis, Sudden infant death syndrome, Vasodilatation
SMQs:, Agranulocytosis (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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: 1996-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: AR971

Write-up: pt had chickenpox 25DEC & ear infect @ some time on ATB;child had wheeze since born;pt recv vax & was fussy & felt warm;no temp measured;20JAN devel sl cold-clear mucous;child found not breathing 9:15;poss SIDS autopsy pending;


VAERS ID: 93813 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1997-01-06
Onset:1997-01-06
   Days after vaccination:0
Submitted: 1997-01-10
   Days after onset:4
Entered: 1997-01-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6H71044 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 6B71090 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0742A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Anorexia, Apnoea, Cough, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-09
   Days after onset: 3
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: Mylicon drops, APAP, glycerin supp
Current Illness: constipation
Preexisting Conditions: prematurity 30wk;bilat inguinal hernia;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt devel a fever of 102 in evening same day of vax;also had dec appetite, cough & runny nose;parent stated that pt cried alot & had a cough & temp of 102.5;pt stopped stopped breathing;


VAERS ID: 93901 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Mississippi  
Vaccinated:1996-11-18
Onset:1996-11-24
   Days after vaccination:6
Submitted: 1997-01-14
   Days after onset:51
Entered: 1997-01-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438090 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 05190 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 438113 / 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: 1996-11-24
   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: intolerance to prosobee infant formula
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: MS96056

Write-up: SIDS death;no report of suspected vaccine assoc made by parents or MD;death certificate is attached;


VAERS ID: 93968 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1996-10-24
Onset:1996-10-25
   Days after vaccination:1
Submitted: 1996-11-01
   Days after onset:7
Entered: 1997-01-23
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


VAERS ID: 94040 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alabama  
Vaccinated:1996-12-27
Onset:1996-12-29
   Days after vaccination:2
Submitted: 1997-01-07
   Days after onset:9
Entered: 1997-01-27
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-29
   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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


VAERS ID: 94052 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1996-10-09
Onset:1996-10-28
   Days after vaccination:19
Submitted: 1997-01-23
   Days after onset:87
Entered: 1997-01-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Confusional state, Drug ineffective, Dyspnoea, Gait disturbance, Infection, Peripheral vascular disorder, Pneumonia, Sepsis
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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: 1996-12-10
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111595

Write-up: pt recv vax 9OCT96 & 28OCT96 pt exp pneumococcal septicemia & a lt lower lobe pneumonia;pt hosp;


VAERS ID: 94506 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted: 1997-01-26
Entered: 1997-01-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: congested, lethargic, not eating;


VAERS ID: 94483 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1997-01-09
Onset:1997-01-10
   Days after vaccination:1
Submitted: 1997-01-10
   Days after onset:0
Entered: 1997-01-30
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 440745 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0640D / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0748L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: saline nose drops
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX97005

Write-up: mom woke up & found pt deceased;MD office notified by ER;initial dx SIDS;


VAERS ID: 94611 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1996-11-21
Onset:1996-11-23
   Days after vaccination:2
Submitted: 1997-01-29
   Days after onset:67
Entered: 1997-01-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dysphagia, Haemorrhage, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (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), Gastrointestinal ulceration (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-17
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 56 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


VAERS ID: 94615 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1997-01-30
Entered: 1997-02-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Neuropathy
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97011979

Write-up: pt recv vax in 1983 & a few years later pt expired from neurologic problems;no further info was provided;


VAERS ID: 94658 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1996-10-16
Onset:1996-11-08
   Days after vaccination:23
Submitted: 1997-01-28
   Days after onset:81
Entered: 1997-02-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438620 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1112 / 1 RL / SC

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: 1996-11-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: SIDS death-8NOV96;pt recv vax 16OCT96;


VAERS ID: 94661 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:1996-11-05
Onset:1996-11-06
   Days after vaccination:1
Submitted: 1997-02-03
   Days after onset:89
Entered: 1997-02-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0642D / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypokinesia, Unevaluable event
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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Nasal congestion/URI
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: medical exam evaluation
CDC Split Type:

Write-up: pt recv vax & became sl cyanotic & lifeless;pt taken to ER;pt given CPR & IV fluids;pt & parent sleeping in sofa bed;


VAERS ID: 94662 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: South Carolina  
Vaccinated:1996-12-20
Onset:1996-12-20
   Days after vaccination:0
Submitted: 1996-12-31
   Days after onset:11
Entered: 1997-02-06
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


VAERS ID: 94790 (history)  
Form: Version 1.0  
Age: 0.35  
Sex: Female  
Location: South Carolina  
Vaccinated:1996-01-05
Onset:1996-01-12
   Days after vaccination:7
Submitted: 1997-01-30
   Days after onset:384
Entered: 1997-02-10
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 431965 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0730L / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-10
   Days after onset: 333
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: NONE
CDC Split Type:

Write-up: None stated.


VAERS ID: 94919 (history)  
Form: Version 1.0  
Age: 0.13  
Sex: Male  
Location: Florida  
Vaccinated:1997-02-04
Onset:1997-02-05
   Days after vaccination:1
Submitted: 1997-02-10
   Days after onset:5
Entered: 1997-02-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438088 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2201A2 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 438122 / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
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: 1997-02-05
   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: Triaminic ped drops
Current Illness: stuffy nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt found expired 945AM 5FEB97;sl fussy during evening;


VAERS ID: 94920 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:1996-04-01
Onset:1996-05-01
   Days after vaccination:30
Submitted: 1997-02-06
   Days after onset:281
Entered: 1997-02-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Acute myeloid leukaemia, Dizziness, Ecchymosis, Vertigo
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Vestibular disorders (narrow), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1996-06-24
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Prozac, Relafan, Sinequan, Premarin
Current Illness: orthapedic prob
Preexisting Conditions: PCN, arythromycin, sulfa, diverticulitis coccois
Allergies:
Diagnostic Lab Data: Bone marrow sample;
CDC Split Type:

Write-up: pt recv vax & approx 3wk later was dx w/acute promyelocytic leukemia & died on 24JUN96-prev hosp JAN96 unrelated illness prior to vax 2nd dose;dizziness, vertigo, bruising in legs;


VAERS ID: 94921 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:1996-07-21
Submitted: 1997-02-10
   Days after onset:204
Entered: 1997-02-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Congenital anomaly, Intestinal perforation, Neonatal disorder, Premature labour
SMQs:, Congenital, familial and genetic disorders (narrow), Gastrointestinal perforation (narrow), Ischaemic colitis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamins, prenatal
Current Illness:
Preexisting Conditions: prematurity; mild hyaline membrane disease
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97020001

Write-up: 23JUL96 pt exp free air in small bowel w/multiple perforations which required surgery;14SEP96 pt died;COD unk;reporter felt pt exp of perforated bowel & hyaline membrane disease r/t prematurity;


VAERS ID: 94930 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Unknown  
Vaccinated:1996-12-20
Onset:1996-12-20
   Days after vaccination:0
Submitted: 1997-01-20
   Days after onset:31
Entered: 1997-02-18
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Anaphylactoid reaction, Haemorrhage, Hypoxia, Oedema, Petechiae, Pneumonia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-20
   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: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spectrophotometry of the HIBTITER & poliomyelitis vax vials was negative for psychotropic or narcotic drugs;infrared exam of the nursing bottle was negative;
CDC Split Type: 897022010L

Write-up: pt recv vax & became irritable;2 hr & 40min post vax pt was found dead in cradle;autopsy results stated visceral congestion compatible w/anaphylactic shock subsequent to vax against H. influenzae;


VAERS ID: 94965 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1996-12-06
Onset:1996-12-07
   Days after vaccination:1
Submitted: 1997-01-27
   Days after onset:51
Entered: 1997-02-20
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 439192 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 440067 / 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: 1996-12-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: pt healthy
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: from autopsy-all labs nl, no physical findings;
CDC Split Type: MN97033

Write-up: death approx 17-19hr p/vax;autopsy report list SIDS as COD;


VAERS ID: 95164 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1997-01-07
Onset:1997-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1997-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434810 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 434993 / 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: 1997-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: OR9702

Write-up: SIDS w/in 6hr of vax;


VAERS ID: 95332 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New York  
Vaccinated:1997-01-02
Onset:1997-01-02
   Days after vaccination:0
Submitted: 1997-02-26
   Days after onset:55
Entered: 1997-03-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 433565 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1317D / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 242K3 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Congenital anomaly, Haemorrhage, Otitis media, Pharyngitis, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Ventricular tachyarrhythmias (narrow), Congenital, familial and genetic disorders (narrow), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: transposition of great vessels (corrected @ birth);
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death in evening p/vax while being fed;


VAERS ID: 95601 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maryland  
Vaccinated:1997-02-25
Onset:0000-00-00
Submitted: 1997-03-10
Entered: 1997-03-12
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436791 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2211A2 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0843 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-06
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:
CDC Split Type:

Write-up: found dead face-down in crib by babysitter, probably SIDS;


VAERS ID: 95865 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1991-08-30
Onset:1992-12-15
   Days after vaccination:473
Submitted: 1997-03-12
   Days after onset:1548
Entered: 1997-03-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1150T / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-30
   Days after onset: 895
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt mom & w siblings tested positive for Von Willebrand''s disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES97030028

Write-up: pt recv vax & devel ITP & was hosp;MAY95 pt devel ITP for a 2nd time & died;


VAERS ID: 95866 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New York  
Vaccinated:1996-12-03
Onset:1997-01-12
   Days after vaccination:40
Submitted: 1997-02-26
   Days after onset:45
Entered: 1997-03-18
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438087 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1405B / UNK GM / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 67478 / UNK MO / PO

Administered by: Private       Purchased by: Other
Symptoms: CSF test abnormal, Drug ineffective, Infection, Meningitis, Somnolence
SMQs:, Lack of efficacy/effect (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-15
   Days after onset: 3
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: anti-haemophilus titer <0.3;IgG-217 (low nl for this lab);IgM & IgA levels reportedly nl;CSF reportedly positive for haemophilus influenzae type b;
CDC Split Type: 897059011L

Write-up: pt recv vax & became lethargic;pt was taken to local hosp, dx of HIB meningitis was made following LP;pt was transferred to ped ICU of tertiary care ctr where pt died 3 days later;


VAERS ID: 96337 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1997-01-16
Onset:1997-01-21
   Days after vaccination:5
Submitted: 1997-02-03
   Days after onset:13
Entered: 1997-03-20
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 433360 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0614315 / 1 RA / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L1197 / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Cardiomegaly, HIV test positive
SMQs:, Cardiac failure (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-22
   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: Bactrim;Polyvisol
Current Illness: NONE
Preexisting Conditions: HIV positive (PCR negative) VSD;SGA/ positive toxicology cocaine;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt found dead in crib on 21JAN97;


VAERS ID: 96397 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1997-02-07
Onset:1997-02-13
   Days after vaccination:6
Submitted: 1997-03-04
   Days after onset:19
Entered: 1997-03-21
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434808 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0757F / 2 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Cyanosis, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autospy dx SIDS;
CDC Split Type: TN97019

Write-up: pt died from SIDS 6 days p/vax;


VAERS ID: 96398 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Tennessee  
Vaccinated:1997-02-18
Onset:1997-02-26
   Days after vaccination:8
Submitted: 1997-02-27
   Days after onset:1
Entered: 1997-03-21
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434814 / 4 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0393D / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ?
Current Illness: unk
Preexisting Conditions: premie-7wk early followed @ hosp
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN97018

Write-up: death-asthma attack in MD office 26FEB97 & expired;had gone to hosp 25FEB97 to MD;


VAERS ID: 96414 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1997-03-10
Onset:1997-03-13
   Days after vaccination:3
Submitted: 1997-03-17
   Days after onset:4
Entered: 1997-03-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6M71184 / 5 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 7984602 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 753D2 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Alanine aminotransferase increased, Cardiac arrest, Hypotonia, Pyrexia, Red blood cell abnormality, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PEN-VK 250mg BID folate
Current Illness: NONE
Preexisting Conditions: hemoglobin SC disease
Allergies:
Diagnostic Lab Data: HgB sl dec;CBC 3 rd day p/other-WBC 7.6;91P, 10L, 7M, SGPT 24, reticulocyte 1.7;
CDC Split Type:

Write-up: 60-70hr p/vax pt devel temp to 103, vomited several times;nl CBC;saw MD;vomited x 1, went limp, cardiac arrest;


VAERS ID: 96415 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1997-03-04
Onset:1997-03-07
   Days after vaccination:3
Submitted: 1997-03-18
   Days after onset:11
Entered: 1997-03-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6D81396 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M270PA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diflucan
Current Illness: NONE x/oral thrush
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: sudden death


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=12&PERPAGE=100&DIED=Yes


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166