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VAERS ID: 96434 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Carolina  
Vaccinated:1995-10-27
Onset:1995-10-28
   Days after vaccination:1
Submitted: 1997-03-20
   Days after onset:509
Entered: 1997-03-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429318 / UNK LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1418W / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0727B / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Chills, Convulsion, Haemolysis, Paralysis, Stupor, Unevaluable event
SMQs:, Haemolytic disorders (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-10
   Days after onset: 409
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & had episodes of shivering & an unusal gaze;12JAN96 dx complex partoid sz (epilepsy) w/Todd''s paralysis;12MAR96 pt had a gen sz lasting ($g60min);pt hosp @ least 1time/mo d/t sz;pt found dead in crib-position on abd;


VAERS ID: 96568 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1997-02-10
Onset:1997-02-12
   Days after vaccination:2
Submitted: 1997-03-20
   Days after onset:36
Entered: 1997-03-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6M71184 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2116A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035PE / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0359 / 1 LL / SC

Administered by: Private       Purchased by: Private
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: 1997-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 27JAN97 haemophilus influenzae b meningitis;d/c 5FEB97;
CDC Split Type:

Write-up: pt remained afeb & asymptomatic following vax, but was found apneic & asystolic w/in 48hr of vax by daycare worker;efforts to resuscitate pt were unsuccessful;


VAERS ID: 96570 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Arizona  
Vaccinated:1997-02-26
Onset:1997-02-28
   Days after vaccination:2
Submitted: 1997-03-19
   Days after onset:19
Entered: 1997-03-31
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 440644 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Somnolence, Urinary incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-03
   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: fever, cough 2 days afeb 26FEB97
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: pt began vomiting on 28FEB97 t/c to MD on call 2MAR97 711PM describes vomiting no diarrhea no blood in vomit;urinating, sleeping but easily arousable;advice given w/instructions to call back if sx inc & in AM for appointment;


VAERS ID: 96626 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Iowa  
Vaccinated:1997-01-31
Onset:1997-02-05
   Days after vaccination:5
Submitted: 1997-03-13
   Days after onset:36
Entered: 1997-04-01
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6J71104 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1197B / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 6L71152 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 438119 / 2 MO / PO

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

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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hosp 19DEC96 w/bronchiolitis;30wk preterm, BW 3-6, hosp 4wks
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 31JAN97 in good hlth;found dead in mom bed on 5FEB97;post mortem found no apparent cause;


VAERS ID: 96633 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:1997-01-08
Onset:0000-00-00
Submitted: 1997-03-26
Entered: 1997-04-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1015D / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Acidosis, Convulsion, Dyspnoea, Encephalopathy, Hepatic failure, Immune system disorder, Infection, Pneumonia
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LP - negative for viral activity
CDC Split Type: WAES97030604

Write-up: pt recv vax & exp snoring abnormally & was hosp;pt was treated & sent home;a few days later pt exp convuls & was hosp again;it was reported they had been unable to control the sz & pt had to be comatosed;sx persisted & remain hosp;


VAERS ID: 96696 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1997-01-21
Onset:1997-02-09
   Days after vaccination:19
Submitted: 1997-03-26
   Days after onset:45
Entered: 1997-04-04
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5K71049 / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0370D / 1 RL / -

Administered by: Private       Purchased by: Private
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: 1997-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: APAP liquid;
Current Illness: parents pointed out sl congestion thought d/t exposure to fine placed smoke MD
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy report
CDC Split Type:

Write-up: pt died 9FEB97;19 days p/vax;prior rxn-high temp 102 24hr w/in receiving shot;COD SIDS; APAP administered;


VAERS ID: 96698 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Missouri  
Vaccinated:1997-03-10
Onset:1997-03-20
   Days after vaccination:10
Submitted: 1997-03-25
   Days after onset:5
Entered: 1997-04-04
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0795470 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1555D / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0795470 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0216 / 1 LL / SC

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Lung disorder, Petechiae, Pulmonary oedema, Pyrexia
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: pt was being monitored for weight gain;
Preexisting Conditions: 1 wt loss 2 bilat conjunctivitis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MO97014

Write-up: pt recv word that pt had died on 20MAR97;pt had been sent to ER for fever of 103 approx;


VAERS ID: 96864 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Arizona  
Vaccinated:1997-03-21
Onset:1997-03-28
   Days after vaccination:7
Submitted: 1997-03-31
   Days after onset:3
Entered: 1997-04-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Infection, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC Split Type: AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


VAERS ID: 96889 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: New Hampshire  
Vaccinated:1996-09-24
Onset:1996-10-03
   Days after vaccination:9
Submitted: 1997-04-02
   Days after onset:181
Entered: 1997-04-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1289A / UNK - / -

Administered by: Private       Purchased by: Unknown
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: 1996-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: 34 6/7wk premature
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH96030

Write-up: by history died of SIDS;was off the monitor which was discharged home with;on the floor having fallen asleep w/mom on couch;


VAERS ID: 96890 (history)  
Form: Version 1.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:1996-12-20
Onset:0000-00-00
Submitted: 1997-04-09
Entered: 1997-04-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Asthma, Cardiovascular disorder, Haemoptysis, Sarcoma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: ?congenital birth defect & pre-existing condions;
Allergies:
Diagnostic Lab Data: autopsy done
CDC Split Type:

Write-up: per husband feeling of weakness, coughing up blood, wheezing;


VAERS ID: 96948 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-02
Onset:1996-10-03
   Days after vaccination:1
Submitted: 1996-11-18
   Days after onset:46
Entered: 1997-04-16
   Days after submission:148
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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: Procardia XL 30mg
Current Illness:
Preexisting Conditions: HTN, coronary artery disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax and shortly p/vax died;MD does not feel that the shot contributed to death;pt recv flu vax in past w/no adverse effects;COD MI;


VAERS ID: 96949 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-28
Onset:1996-10-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Conduction defects (narrow), Embolic and thrombotic events, arterial (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


VAERS ID: 96957 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arizona  
Vaccinated:1996-09-17
Onset:1996-09-20
   Days after vaccination:3
Submitted: 1997-01-20
   Days after onset:122
Entered: 1997-04-18
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5E71074 / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 438125 / 1 MO / PO

Administered by: Private       Purchased by: Private
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: 1996-09-21
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: near sudden infant death
CDC Split Type:

Write-up: pt found not breathing on 20SEP96 3 days p/vax;


VAERS ID: 96960 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kansas  
Vaccinated:1997-02-18
Onset:0000-00-00
Submitted: 1997-04-14
Entered: 1997-04-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 434813 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 436960 / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Infection, Lung disorder, Petechiae, Pneumonia, Pulmonary oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 1997-03-10
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: cold
Preexisting Conditions: poss maternal drug use (mom tested poss for meth use 1mo p/birth);
Allergies:
Diagnostic Lab Data: positive for antihistamine & APAP
CDC Split Type:

Write-up: no adverse effects from immun;


VAERS ID: 96961 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Ohio  
Vaccinated:1997-03-25
Onset:1997-03-26
   Days after vaccination:1
Submitted: 1997-03-31
   Days after onset:5
Entered: 1997-04-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 432684 / 1 LL / IM

Administered by: Public       Purchased by: Other
Symptoms: Abdominal pain, Apnoea, Cardiac arrest, Drug ineffective, Infection, Pneumonia, Pyrexia, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-27
   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: sickle cell disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: 897092004L

Write-up: pt recv vax 25MAR97 & the next day devel a fever of 103 & was described as walking, drinking & urinating;27MAR97 pt was brought into ER @ 810AM & was dead on arrival;autopsy results pending @ date of report;suspected pneumococcal sepsis;


VAERS ID: 97015 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New Hampshire  
Vaccinated:1996-12-30
Onset:1997-01-10
   Days after vaccination:11
Submitted: 1997-01-14
   Days after onset:4
Entered: 1997-04-21
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neonatal disorders (narrow), Dehydration (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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


VAERS ID: 97016 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1996-09-02
Onset:1996-10-26
   Days after vaccination:54
Submitted: 1997-01-17
   Days after onset:83
Entered: 1997-04-21
   Days after submission:93
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0165D / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-26
   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: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH97001

Write-up: SIDS


VAERS ID: 97165 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1997-04-23
Onset:1997-04-23
   Days after vaccination:0
Submitted: 1997-04-24
   Days after onset:1
Entered: 1997-04-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6K81424 / 1 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 216782 / 2 - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 6D81391 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 208407 / 1 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: 1997-04-24
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7199

Write-up: pt recv vax 23APR97 & it was reported that about 423AM on 24APR97 pt was found expired in crib;pt reportedly had unremarkable med hx & had a nl develop;MD felt was instance of crib death (SIDS);


VAERS ID: 97336 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Texas  
Vaccinated:1997-04-28
Onset:1997-04-28
   Days after vaccination:0
Submitted: 1997-05-01
   Days after onset:3
Entered: 1997-05-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / 2 - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 7M81526 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 75684 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 242
CDC Split Type: CO7230

Write-up: SIDS;pt recv vax 28APR97 & later that afternoon pt was found expired by babysitter who had put pt down fro a nap;pt was transported to ER:ER is attributing incident to SIDS;


VAERS ID: 97432 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1997-04-15
Onset:1997-04-17
   Days after vaccination:2
Submitted: 1997-04-21
   Days after onset:4
Entered: 1997-05-07
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444260 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035PE / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. MD443 / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Delirium, Hyperkinesia, Lung disorder, Pneumonia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Akathisia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-18
   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: Amoxicillin
Current Illness: BOM
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy in process, viral pneumonia noted;
CDC Split Type: NC97033

Write-up: found by babysitter to be apneic & startled, vomited & loss consciousness, needed CPR:


VAERS ID: 98029 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Illinois  
Vaccinated:1997-05-09
Onset:1997-05-14
   Days after vaccination:5
Submitted: 1997-05-14
   Days after onset:0
Entered: 1997-05-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441097 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2251A2 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 441188 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Infection, Pneumonia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (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: 1997-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propulsid;Zantac, MOM
Current Illness: NONE
Preexisting Conditions: GE reflux;
Allergies:
Diagnostic Lab Data: autopsy to be performed on 15MAY97;
CDC Split Type:

Write-up: pt was put to bed (crib) to sleep 9:45AM & was found unresponsive 1045AM;


VAERS ID: 98043 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Texas  
Vaccinated:1997-04-24
Onset:1997-04-27
   Days after vaccination:3
Submitted: 1997-04-29
   Days after onset:2
Entered: 1997-05-16
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 440745 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0758A / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Neoplasm, Oedema, Respiratory disorder, Somnolence, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 897121006L

Write-up: 3 days post vax pt adm to hosp w/a gen rash, lethargy & vomiting;on admission, pt was afeb & in no distress; 4 days post vax pt exp a resp arrest & died;


VAERS ID: 98044 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1995-07-18
Onset:0000-00-00
Submitted: 1997-04-23
Entered: 1997-05-16
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 390955 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1308A2 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0721K / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Infection, Petechiae, Pneumonia, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: 1995-08-08
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 897133011L

Write-up: pt recv vax & no further info was available @ the date of this report, which was received as part of litigation proceedings;


VAERS ID: 98130 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Hawaii  
Vaccinated:1997-05-10
Onset:1997-05-13
   Days after vaccination:3
Submitted: 1997-05-16
   Days after onset:3
Entered: 1997-05-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444258 / 3 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1481D / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 440737 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-05-13
   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: premature infant (34weeks) (birth wt. 4-12, ht. 17 1/2);
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden infant death synd;no prev sx;


VAERS ID: 98133 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alabama  
Vaccinated:1997-04-16
Onset:1997-04-20
   Days after vaccination:4
Submitted: 1997-05-14
   Days after onset:24
Entered: 1997-05-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 434989 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AL9714

Write-up: 18APR97 @ 7PM mom took pt to ER;dx w/URI-had fever of 100;20APR97 @ 04:00 mom brought pt into ER-DOA-coroner says SIDS-no autopsy;


VAERS ID: 98134 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Alabama  
Vaccinated:1997-05-05
Onset:1997-05-07
   Days after vaccination:2
Submitted: 1997-05-13
   Days after onset:6
Entered: 1997-05-22
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438090 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1593B / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0747D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-05-07
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AL9716A

Write-up: baby found dead in crib;coroner ruled death from SIDS; (baby on water bed);


VAERS ID: 98253 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1996-11-19
Onset:1997-03-20
   Days after vaccination:121
Submitted: 1997-05-21
   Days after onset:61
Entered: 1997-05-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PLAGUE: PLAGUE (USP) / GREER LABORATORIES, INC. 0829Y1 / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Arrhythmia, Cardiac arrest, Cardiomyopathy, Cardiovascular disorder, Stupor, Syncope
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 (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: COD deferred;manner of death deferred;
CDC Split Type: 0

Write-up: pt recv vax on 9SEP96 & 19NOV96;pt was due for 3rd dose on 22APR97 & pt died 20MAR97 while playing basketball;initial listed COD is dilated cardiomyopathy;pt collapsed & became rapidly unresponsive;


VAERS ID: 98257 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: West Virginia  
Vaccinated:1978-05-26
Onset:1978-05-31
   Days after vaccination:5
Submitted: 1997-05-22
   Days after onset:6931
Entered: 1997-05-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Brain oedema, Bronchitis, Infection, Meningitis, Pneumonia
SMQs:, Noninfectious meningitis (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: 1978-05-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & 5 days post vax was dx w/acute meningitis, viral type, cerebral edema, bronchitis, diffuse, interstitial pneumonia;


VAERS ID: 98471 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-12-02
Onset:1996-12-07
   Days after vaccination:5
Submitted: 1997-05-30
   Days after onset:173
Entered: 1997-06-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6B71087 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 6B71087 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L1112 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Congenital anomaly, Sudden infant death syndrome
SMQs:, Congenital, familial and genetic disorders (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mult vitamins w/iron;APAP
Current Illness: NONE
Preexisting Conditions: poss cranosinostosis, maternal syphlis-treated;
Allergies:
Diagnostic Lab Data: 5Dec96 skull x-ray - bradycephalic; poss mid inf coronal suture closure
CDC Split Type: CO7291

Write-up: pt recv vax 2DEC96 & 4 days post vax 7DEC96 pt died as a sudden infant death;It was also reported that skull x-ray done on 5DEC showed the pt was bradycephalic;poss mid inf coronal suture closure;


VAERS ID: 98478 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Texas  
Vaccinated:1997-03-07
Onset:1997-03-07
   Days after vaccination:0
Submitted: 1997-03-11
   Days after onset:4
Entered: 1997-06-03
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0804210 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1025D / 3 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0804210 / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0747E / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Infection, Lung disorder
SMQs:

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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX97049

Write-up: parents took pt to ER that evening & reporter was notified by legal office that pt died-ER report listed SIDS;autopsy report listed severe viral infect;no adverse events noted @ clinic;


VAERS ID: 98591 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oklahoma  
Vaccinated:1997-03-17
Onset:1997-03-26
   Days after vaccination:9
Submitted: 1997-05-30
   Days after onset:64
Entered: 1997-06-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441103 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0755L / 1 MO / PO

Administered by: Private       Purchased by: Private
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: 1997-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: cough-no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autospy report pending;
CDC Split Type:

Write-up: pt recognized @ daycare to be apneic sent to hosp where declared deceased SIDS;


VAERS ID: 99047 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1997-06-02
Onset:1997-06-09
   Days after vaccination:7
Submitted: 1997-06-10
   Days after onset:1
Entered: 1997-06-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


VAERS ID: 99050 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Ohio  
Vaccinated:1997-04-28
Onset:1997-05-04
   Days after vaccination:6
Submitted: 1997-05-08
   Days after onset:4
Entered: 1997-06-17
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438087 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0750M / 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: 1997-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy-report not completed @ this time;
CDC Split Type: OH97038

Write-up: SIDS death


VAERS ID: 99134 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Jersey  
Vaccinated:1997-04-07
Onset:1997-04-09
   Days after vaccination:2
Submitted: 1997-05-05
   Days after onset:26
Entered: 1997-06-20
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 440744 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0749B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Depressed level of consciousness, Hypotonia, Pneumonia, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-04-11
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pH 6.877;PCO2 24.5;HCO3 115.0;Hb 11.4;
CDC Split Type: NJ9719

Write-up: pt stopped breathing & unresponsive for unk period prior to arrival @ ER;cyanotic;comatose, conjugate gaze;BP 23/13;limp, cold, pupils fixed, dilated;on respirator;hypotonic;cardio pulm arrest r/o sepsis r/o CNS bleed;


VAERS ID: 99176 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1996-11-08
Onset:1996-11-09
   Days after vaccination:1
Submitted: 1997-06-10
   Days after onset:212
Entered: 1997-06-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 431966 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1281D / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0739A / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Stupor, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD SIDS, pulmonary edema & congestion;
CDC Split Type: VA9708

Write-up: pt was found unresponsive @ home & taken to hosp ER @ 5:35AM where pt was pronounced deat;last seen alive by mother @ 10PM:


VAERS ID: 99483 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1997-04-10
Onset:1997-04-23
   Days after vaccination:13
Submitted: 1997-06-25
   Days after onset:63
Entered: 1997-07-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 433566 / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1438D / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER M0843 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death 23APR97; nl emergency procedures-trach tube, CPR;


VAERS ID: 99817 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: California  
Vaccinated:1997-05-29
Onset:1997-05-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1997-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6B81268 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2237RTZ / 2 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M305PN / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 07500 / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Diarrhoea, Grand mal convulsion, Hypotonia, Hypoxia, Pyrexia, Stupor, Tachycardia
SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-05-31
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Robinal, Fronotidine;Cisapride, Iron, vits
Current Illness:
Preexisting Conditions: severe hypoxic encephalopathy;birth, multiple pneumoniac, UTI x2, GERD, chronic iron chorrhea;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever to 108, diarrhea x8, floppy, tachycardia, sz, AHOC, tachy-status eplipticus, died;tx APAP, 02, Motrin, Rocephin, Ativan x3, Phenobarb;


VAERS ID: 99818 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1997-04-29
Onset:1997-04-30
   Days after vaccination:1
Submitted: 1997-06-04
   Days after onset:35
Entered: 1997-07-07
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 432654 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 441236 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Rhinitis, Sudden infant death syndrome, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-05-06
   Days after onset: 6
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: 2JUN preliminary coroners report SIDS:
CDC Split Type: PA9747

Write-up: pt recv vax 29APR97 & 30APR c/o congestion advised humidifier & nose gtts;s/s resp distress;3MAY & 4MAY seen in ER c/o congestion;6MAY infant in bed w/aprent;dad awakened to find pt not breathing;paramedics & CHP ER unable to resusitate;


VAERS ID: 99837 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:1996-04-13
Submitted: 1997-07-03
   Days after onset:446
Entered: 1997-07-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1996-04-14
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97062171

Write-up: pt recv vax 1986 & 13APR96 pt was hosp w/probable pneumococcal infect;On 14APR96 pt died;COD was pneumococcal sepsis;


VAERS ID: 99842 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Arizona  
Vaccinated:1996-02-29
Onset:1996-03-06
   Days after vaccination:6
Submitted: 1997-07-01
   Days after onset:481
Entered: 1997-07-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426115 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0094B / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7334E / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Apnoea, Cyst, Encephalitis, Infection, Lymphadenopathy, Pneumonia, Vasodilatation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report: interstitual pneumonia, mesenteric lymphadenopathy, passive congestion of viscera, benign ovarian cysts, & acute encephalomyelitis;COD pneumonia;
CDC Split Type:

Write-up: 6 days p/vax pt died suddenly @ home;father was holding pt & fell asleep when awoke pt not breathing- had be fussier than usual;Autopsy report: interstitual pneumonia, mesenteric lymphadenopathy, passive congestion of viscera;COD pneumonia


VAERS ID: 100174 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Washington  
Vaccinated:1997-02-07
Onset:1997-02-11
   Days after vaccination:4
Submitted: 1997-02-18
   Days after onset:7
Entered: 1997-07-14
   Days after submission:145
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441098 / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1131D / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 441188 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Petechiae, Pneumonia, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: 1997-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: mild URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed 12FEB97;
CDC Split Type: WA971364

Write-up: death 11FEB97 6PM;autopsy result SIDS: autopsy report given pathological dx SIDS w/intrathoracic visceral petechiae, visceral congestion & minute foci of early bronchopenumonia;


VAERS ID: 100217 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New York  
Vaccinated:1997-07-01
Onset:1997-07-02
   Days after vaccination:1
Submitted: 1997-07-11
   Days after onset:9
Entered: 1997-07-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2250A2 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7A91570 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 766C1 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: Autopsy: SIDS
CDC Split Type:

Write-up: pt found unresponsive in crib 3JUL97 230PM;


VAERS ID: 100228 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New York  
Vaccinated:1997-06-30
Onset:1997-07-06
   Days after vaccination:6
Submitted: 1997-07-10
   Days after onset:4
Entered: 1997-07-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7J81535 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M300PN / 1 LL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0443 / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-07-06
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax; was found not breathing; brought to hosp; pt pronounced dead on arrival; presumed SIDS 6 days posy vax;


VAERS ID: 100310 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nebraska  
Vaccinated:1997-07-15
Onset:1997-07-16
   Days after vaccination:1
Submitted: 1997-07-17
   Days after onset:1
Entered: 1997-07-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 439192 / UNK LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2294A2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 436954 / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv HEP B vax by SKB lot# 2294A ;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA


VAERS ID: 100353 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1997-07-09
Onset:1997-07-09
   Days after vaccination:0
Submitted: 1997-07-10
   Days after onset:1
Entered: 1997-07-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 444042 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2235A2 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0759F / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Congenital anomaly, Heart disease congenital, Lung disorder, Neoplasm, Pulmonary oedema, Stupor
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-09
   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: Digoxin, Lasix, Captopril, ASA
Current Illness: NONE
Preexisting Conditions: hypoplastic lt heart synd;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11AM pt recv vax;330PM pt fussy, irritable laid down for nap;4PM found unresponsive-family called attempted resus;Time of death 5PM;hx of poss sz per mom;


VAERS ID: 100355 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1997-06-10
Onset:1997-06-12
   Days after vaccination:2
Submitted: 1997-07-15
   Days after onset:33
Entered: 1997-07-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81602 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1438D / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 7A91570 / 1 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L1108 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-06-12
   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: NONE
Allergies:
Diagnostic Lab Data: full autopsy results not available yet;
CDC Split Type:

Write-up: apparent SIDS;


VAERS ID: 100361 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1997-06-07
Onset:1997-06-20
   Days after vaccination:13
Submitted: 1997-07-18
   Days after onset:28
Entered: 1997-07-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Hepatic failure, Hepatitis, Infection, Nausea, Sepsis, Vomiting
SMQs:, Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-07-10
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergy, vicodin
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97070708

Write-up: pt recv vax 7JUN97 & 20JUN97 pt exp poss liver failure, severe hepatitis & was hosp;the reporter was unsure if the pt had prev exposure to hep b virus & stated that it is not known whether pt exp & r/t vax w/hep B vax;


VAERS ID: 100366 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Mississippi  
Vaccinated:1997-07-06
Onset:1997-07-07
   Days after vaccination:1
Submitted: 1997-07-18
   Days after onset:11
Entered: 1997-07-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Cerebral ischaemia, Encephalopathy, Myocardial infarction, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-10
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: No evidence of severe hypoxic brain injury;autopsy w/o evidence of anomalies;
CDC Split Type:

Write-up: pt adm to PICU on 7JUL97 p/being found apneic & pulseless in crib @ home about 5:30AM;pt did not eventually survive this event;approx (?) 20hr earlier recv vax;


VAERS ID: 100798 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Louisiana  
Vaccinated:1997-07-21
Onset:1997-07-22
   Days after vaccination:1
Submitted: 1997-07-25
   Days after onset:3
Entered: 1997-07-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2233BD / 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: 1997-07-22
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: waiting for autopsy
CDC Split Type:

Write-up: pt died during the noc p/the hepatitis vax was given;@ this point the coroner believes it is d/t SIDS;


VAERS ID: 101297 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1997-06-02
Onset:0000-00-00
Submitted: 1997-08-01
Entered: 1997-08-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1618D / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abscess, Hepatic failure, Hepatic function abnormal, Hepatitis, Hepatocellular damage, Infection, Jaundice, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-07-10
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: waeswae
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES97071534

Write-up: 02jun97 pt recv vax; subsequently the pt exp nausea & vomiting & was hosp; subsequently the pt died."the autopsy results were not complete, but indicated some liver involvement. There were two hosp before the pt death;


VAERS ID: 101298 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-09-13
Onset:1995-09-21
   Days after vaccination:8
Submitted: 1997-08-01
   Days after onset:680
Entered: 1997-08-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Haemorrhage, Hepatic failure, Infection, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Noninfectious encephalitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-06-01
   Days after onset: 619
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC Split Type: WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


VAERS ID: 101313 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:1981-07-01
Submitted: 1997-07-18
   Days after onset:5861
Entered: 1997-08-07
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Diplopia, Drug ineffective, Hypoxia, Immune system disorder, Paralysis, Pneumonia, Poliomyelitis
SMQs:, Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (broad), 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: 1990-10-01
   Days after onset: 3379
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: FFP
Current Illness: common variable immunodeficiency synd
Preexisting Conditions: allergies to cats, dogs, food items, grass, trees; hx of multiple episodes of upper respiratory infect,otitis media, recurrent fever, chronic cough, cinusitis & skin infections
Allergies:
Diagnostic Lab Data: IgG 1975-81-42-330 mg/ dL; IgA 1975 3.8 mg/dL; IgM 1975 4.5 mg/dL; stool specimens 1981-1982- positive for polio type 1
CDC Split Type: 897205001L

Write-up: pt recv 3 IPV 1964-5&OPV 1967-74;12 YO pt dx w/immunodeficiency synd;tx included infusion of FFP 1975-81;jul81fever 104,diarrhea & general weakness;4 days later stiff neck,diplopia & generalized paralysis requiring ventilation;dx polio


VAERS ID: 101316 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1997-06-27
Onset:0000-00-00
Submitted: 1997-07-08
Entered: 1997-08-07
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434808 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1538A2 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0443 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-05
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: GA97089

Write-up: pt found dead @ home-no further details available @ this time;


VAERS ID: 101767 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1997-08-01
Onset:1997-08-05
   Days after vaccination:4
Submitted: 1997-08-11
   Days after onset:6
Entered: 1997-08-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M300PN / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Coma, Epistaxis, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-05
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autospy done
CDC Split Type:

Write-up: infant found unresponsive, not breathing in crib @ daycare;sl amount blood @ nares;EMT brought to ER-cold, resuscitation attempted w/o success;


VAERS ID: 101768 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Idaho  
Vaccinated:1997-08-01
Onset:1997-08-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1997-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6D81391 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195PJ / 3 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-06
   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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: reportedly found in crib in afternoon not breathing & w/o heart beat;to ER by amb-unable to resuscitate;


VAERS ID: 101949 (history)  
Form: Version 1.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:1994-03-21
Onset:1994-03-21
   Days after vaccination:0
Submitted: 1997-08-22
   Days after onset:1249
Entered: 1997-08-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Haematuria, Haemorrhage, Hepatic function abnormal, Infection, Leukaemia, Pancytopenia
SMQs:, Liver related investigations, signs and symptoms (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Myelodysplastic syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-01
   Days after onset: 558
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: BP med;
Current Illness:
Preexisting Conditions: HTN
Allergies:
Diagnostic Lab Data: cbc 94 - normal
CDC Split Type: 970198111

Write-up: pt recv vax & pt wife reported pt had well physical 3wk prior to vax;all bloods counts WNL;p/vax pt had unk rxn;3wk later pt began bleeding through pores & in urine;pt dx w/leukemia;pt expired d/t liver problems in OCT95;


VAERS ID: 102088 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: California  
Vaccinated:1997-08-20
Onset:1997-08-26
   Days after vaccination:6
Submitted: 1997-08-27
   Days after onset:1
Entered: 1997-09-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES MA81601 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2230A / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0847 / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Dermatitis exfoliative, Rash, Skin discolouration
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-26
   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: Nystatin ointment;HC 1% cr
Current Illness: yeast diaper rash
Preexisting Conditions: seborrheic dermatitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt died on 26AUG97;


VAERS ID: 102334 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arkansas  
Vaccinated:1997-04-25
Onset:1997-04-26
   Days after vaccination:1
Submitted: 1997-05-02
   Days after onset:6
Entered: 1997-09-12
   Days after submission:133
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1192D / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 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: 1997-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propulsid & Zantac
Current Illness: Reflux
Preexisting Conditions: Reflux-dx 17APR97 by MD;
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR9762

Write-up: COD SIDS;


VAERS ID: 102335 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oklahoma  
Vaccinated:1997-09-02
Onset:1997-09-03
   Days after vaccination:1
Submitted: 1997-09-04
   Days after onset:1
Entered: 1997-09-12
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446770 / 2 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0571E / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Lung disorder, Oedema, Otitis media, Sepsis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-09-03
   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: NONE
Current Illness: OM
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS


VAERS ID: 102476 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arkansas  
Vaccinated:1997-08-05
Onset:1997-08-10
   Days after vaccination:5
Submitted: 1997-08-22
   Days after onset:12
Entered: 1997-09-15
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0861850 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0115E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0861850 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Infection, Lung disorder, 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: 1997-08-10
   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: APAP for fever
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR9773

Write-up: pt ran fever 100 to 101 for 2 days p/vax but was well day a/died;mom states no signs of illness;taken to hosp suspected SIDS;autopsy being performed;


VAERS ID: 102565 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Texas  
Vaccinated:1997-08-04
Onset:1997-08-05
   Days after vaccination:1
Submitted: 1997-09-04
   Days after onset:30
Entered: 1997-09-19
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81441 / 3 RL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RA / SC

Administered by: Other       Purchased by: Public
Symptoms: Dyspnoea, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-05
   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:
Current Illness: NONE
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found in resp distress on 5AUG97 & subsequently died on way to hosp;


VAERS ID: 102626 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1997-07-25
Onset:1997-07-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1997-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6H71040 / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-08-07
   Days after onset: 12
Permanent Disability? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax lethargic, put on life support taken to hosp, high temp, pronounced dead @ hosp 26JUL97-not breathing;


VAERS ID: 102627 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1997-09-02
Onset:1997-09-02
   Days after vaccination:0
Submitted: 1997-09-16
   Days after onset:14
Entered: 1997-09-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2251A2 / 2 RA / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Anorexia, Rash maculo-papular, Somnolence, Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-09-02
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: runny nose x 1wk;
Preexisting Conditions: pt had sl runny nose for about 1wk;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 970217071

Write-up: immed p/vax 9AM pt went into a deep sleep;woke 30min later still in a light sleep;10AM would not take bottle from a babysitter;APAP given 1230PM w/feeding;sitter checked child 2PM appeared fine;3PM pt found expired; poss SIDS & vax therapy;


VAERS ID: 102677 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Massachusetts  
Vaccinated:1997-09-08
Onset:1997-09-11
   Days after vaccination:3
Submitted: 1997-09-16
   Days after onset:5
Entered: 1997-09-25
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES TJ81535 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M350PN / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 446712 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: 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 (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-09-11
   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: constipation;prematurity (27 wk gestation);cardiac flow murmur;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt seen in MD office for a well visit 8SEP97 pt recv vax same day;pt died 11SEP97 found w/cardiopulmonary arrest @ 1PM while sleeping;


VAERS ID: 102763 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1997-08-01
Onset:1997-08-02
   Days after vaccination:1
Submitted: 1997-09-26
   Days after onset:55
Entered: 1997-09-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7J81535 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 7B91641 / 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: 1997-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7482

Write-up: pt recv vax 1AUG97 & the following day 2AUG97 pt was found dead;


VAERS ID: 102768 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Ohio  
Vaccinated:1997-01-30
Onset:1997-02-04
   Days after vaccination:5
Submitted: 1997-09-15
   Days after onset:222
Entered: 1997-09-29
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438621 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 439871 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Apnoea, Cardiac arrest, Coagulopathy, Haemolytic anaemia, Immune system disorder, Renal failure acute, Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemolytic disorders (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-02-07
   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: Ceftriaxone, tremethoprim;sulfamethoxazole, acetaminophen
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 4FEB positive leukocyte esterase;6FEB hemoglobin 2.3;WBC 65;coombs test positive;
CDC Split Type:

Write-up: 4FEB97 fussy, dec oral intake, fever, nasal congestion;impression: UTI. Plan: ceftriaxone & Bactrim 3/4 teas 12hr x 1wk;6FEB97 lethargy, irritability;hosp hemolytic anemia;7FEB97 acute renal failure, disseminated intravascular coagulation


VAERS ID: 102828 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:1997-06-10
Onset:1997-06-17
   Days after vaccination:7
Submitted: 1997-06-30
   Days after onset:13
Entered: 1997-09-30
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6K71127 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305MP / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0747E / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Atelectasis, Brain oedema, Cyanosis, Ecchymosis, Petechiae, Pulmonary oedema, Skin disorder, Unevaluable event
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-06-17
   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: Albuterol
Current Illness: NONE
Preexisting Conditions: bronchiolitis-resolved, OM, wheezing, asthma;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: TX97074

Write-up: pt recv vax 10JUN97 & passed away;COD postural asphyxiation;manner of death accidental;visceral congestion w/pulmonary atelectasis & pulmonary & cerebral edema;petechial hemorrhages;abrasions;ecchymosis;pt in position could cause compromise


VAERS ID: 102984 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1997-08-26
Onset:1997-09-07
   Days after vaccination:12
Submitted: 1997-09-25
   Days after onset:18
Entered: 1997-10-07
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 445539 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1554D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M300PN / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-09-17
   Days after onset: 10
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: pt died of SIDS on 17SEP97;pt recv vax 26AUG97;


VAERS ID: 103028 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1997-06-27
Onset:0000-00-00
Submitted: 1997-09-23
Entered: 1997-10-08
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441101 / 1 - / L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 0358E / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0758B / 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: 1997-07-09
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: Hydrocele
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL97069

Write-up: Death Certificate certifies COD SIDS


VAERS ID: 103029 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Florida  
Vaccinated:1997-07-18
Onset:0000-00-00
Submitted: 1997-09-23
Entered: 1997-10-08
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0358E / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0443 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL97070

Write-up: died of asphyxia;compression of neck & chest according to death certificate;


VAERS ID: 103228 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1997-08-12
Onset:1997-08-20
   Days after vaccination:8
Submitted: 1997-10-02
   Days after onset:43
Entered: 1997-10-20
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0758M / 2 MO / PO
TTOX: TETANUS TOXOID (NO BRAND NAME) / LEDERLE LABORATORIES 444042 / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Dyspnoea, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CA970080

Write-up: @ time of inj administration no immed rxn noted;


VAERS ID: 103312 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1997-08-25
Onset:1997-08-26
   Days after vaccination:1
Submitted: 1997-08-27
   Days after onset:1
Entered: 1997-10-21
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6M71184 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0761E / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-08-26
   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: Ferinsol
Current Illness: NONE
Preexisting Conditions: hx of ovarian cyst, anemia hgb 9.0 25JUN97;35wk premie;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt found by mom dead in crib @ 1015AM 26AUG97;no apparent sx or signs;


VAERS ID: 103313 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Michigan  
Vaccinated:1997-10-01
Onset:1997-10-02
   Days after vaccination:1
Submitted: 1997-10-03
   Days after onset:1
Entered: 1997-10-21
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6D81396 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7B91590 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1191 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: taken to ER/amb, mom called 911 when unable to arouse p/nap;no visible trauma noted by ER MD:


VAERS ID: 103318 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:1997-10-16
Onset:1997-10-16
   Days after vaccination:0
Submitted: 1997-10-17
   Days after onset:1
Entered: 1997-10-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0049E / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Cardiomyopathy, Congenital anomaly, Hypertrophy, Myopathy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (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: 1997-10-16
   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: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: autopsy report: congenital ideopathic hypertropic cardiac, myopathy;
CDC Split Type:

Write-up: approx 5hr p/vax pt was running laps on athletic field prior to participating in a soccer game;pt collapsed & stopped breathing;CPR was initiated & pt transported to hosp ER;


VAERS ID: 103382 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Michigan  
Vaccinated:1996-01-01
Onset:1997-07-25
   Days after vaccination:571
Submitted: 1997-10-13
   Days after onset:80
Entered: 1997-10-23
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Brain oedema, Cardiomyopathy, Delirium, Hepatomegaly, Infection, Influenza, Myocarditis, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-28
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: viral serology echo/coxsackie virus positive;
CDC Split Type: WAES97100278

Write-up: pt recv vax 1996 & 25JUL97 pt exp flu-like sx & was hosp & was dead by 28JUL97;it was reported that the COD was originally thought to be Reye''s synd but it was discovered child had cardiomyopathy (swelling);lab revealed +echovirus


VAERS ID: 103592 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1997-10-16
Onset:1997-10-17
   Days after vaccination:1
Submitted: 1997-10-22
   Days after onset:5
Entered: 1997-10-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


VAERS ID: 103878 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:1997-09-11
Onset:1997-09-22
   Days after vaccination:11
Submitted: 1997-10-09
   Days after onset:17
Entered: 1997-10-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978168 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, Pneumonia, Respiratory disorder
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-07
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: allergies PCN;LBBB;
Allergies:
Diagnostic Lab Data: neuro consult suggested;polyneuropathy D/T GBS
CDC Split Type:

Write-up: pt recv vax 11SEP97 & came in 22SEP97 w/GBS expired 7OCT97 d/t ARDS secondary to pneumonia secondary to GBS;polyneuropathy d/t GBS;


VAERS ID: 103882 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Minnesota  
Vaccinated:1997-10-03
Onset:1997-10-06
   Days after vaccination:3
Submitted: 1997-10-23
   Days after onset:17
Entered: 1997-10-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91846 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: OM
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy results not available
CDC Split Type:

Write-up: pt was found, dec, p/a nap @ daycare;presumed SIDS;no apparent illness, asymptomatic;autopsy results not available @ this time;


VAERS ID: 104094 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1997-10-28
Onset:1997-10-28
   Days after vaccination:0
Submitted: 1997-10-30
   Days after onset:2
Entered: 1997-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3337GB / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest, Malaise
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 (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: diabetes, others not known
Allergies:
Diagnostic Lab Data: BP was taken @ clu clinic as a routine service offered to pt 130/66;
CDC Split Type: CT9711

Write-up: pt c/o not feeling well while in car w/wife;EMS was called when arrived pt was in cardiac arrest;attempts to revive failed was transported to hosp ER states COD listed on ER record as cardiac arrest;


VAERS ID: 104095 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1997-10-15
Onset:1997-10-15
   Days after vaccination:0
Submitted: 1997-10-16
   Days after onset:1
Entered: 1997-11-03
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3287GB / 1 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-15
   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: GLynase, Corzide
Current Illness:
Preexisting Conditions: HTN, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS97040

Write-up: pt recv vax 15OCT97 830 to 930AM & same day died;corner states COD massive MI;


VAERS ID: 104253 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Maryland  
Vaccinated:1997-10-28
Onset:1997-10-28
   Days after vaccination:0
Submitted: 1997-11-04
   Days after onset:7
Entered: 1997-11-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HC / UNK - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 441214 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Cyanosis, Dyspnoea, Hypothermia, Oedema peripheral, Pallor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-04
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx ETOH, tobacco use;
Allergies:
Diagnostic Lab Data: refused lab work
CDC Split Type:

Write-up: presented on 4NOV @ 926AM immed care w/ SOB, weakness, cyanotic, pallor, swelling lt arm-lateral forearm to hand;swollen since inj;T96.8;expired 4NOV97 @ home;


VAERS ID: 104485 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:1997-11-04
Onset:1997-11-05
   Days after vaccination:1
Submitted: 1997-11-05
   Days after onset:0
Entered: 1997-11-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 447787 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0759A / 2 MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-05
   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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: no sx of fever, pain; put down for nap 930AM;mom in & out of room;found pt w/vomitus-unresponsive;CPR attempts unsuccessful @ hosp;no evidence of relation to vax;


VAERS ID: 104489 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Georgia  
Vaccinated:1997-09-16
Onset:1997-09-18
   Days after vaccination:2
Submitted: 1997-09-18
   Days after onset:0
Entered: 1997-11-10
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2210A2 / 2 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Encephalopathy, Hypoxia, Laryngospasm, Rhinitis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Dystonia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-09-18
   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:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: The autopsy report states laryngospasm.
CDC Split Type: GA97126

Write-up: pt recv vax 16SEP97 & had congestion on 17SEP97 was seen @ hosp & instructed to given saline nose drops;mom mixed 3 tbsp salt to 1 cup of h20 & used as nose gtt;pt immed stopped breathing & was taken to sheriffs office CPR performed to hosp. The autopsy report states laryngospasm.


VAERS ID: 104634 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Maine  
Vaccinated:1997-09-18
Onset:1997-10-14
   Days after vaccination:26
Submitted: 1997-11-11
   Days after onset:28
Entered: 1997-11-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (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, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


VAERS ID: 105112 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Alabama  
Vaccinated:1997-05-07
Onset:1997-05-08
   Days after vaccination:1
Submitted: 1997-11-19
   Days after onset:195
Entered: 1997-11-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Hypotonia, Somnolence, Sudden infant death syndrome, Yawning
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: ~ ()~~~In patient
Other Medications: children''s APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: AL9716A

Write-up: death;autopsy consistent w/SIDS;12-14 hr yawning-nodding;


VAERS ID: 105125 (history)  
Form: Version 1.0  
Age: 100.0  
Sex: Female  
Location: New York  
Vaccinated:1997-10-27
Onset:1997-10-27
   Days after vaccination:0
Submitted: 1997-11-17
   Days after onset:21
Entered: 1997-11-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-30
   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: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


VAERS ID: 105194 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: New York  
Vaccinated:1997-11-06
Onset:1997-11-09
   Days after vaccination:3
Submitted: 1997-11-21
   Days after onset:12
Entered: 1997-11-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978218 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: 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: 1997-11-09
   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:
Current Illness: NONE
Preexisting Conditions: hydroencephaly, shunted hydrocephalis, cerebral palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severely delayed child became lethargic;48hr p/vax brought to ED, expired during CT scan to evaluate shunt status;


VAERS ID: 105197 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1997-10-23
Onset:1997-11-17
   Days after vaccination:25
Submitted: 1997-11-18
   Days after onset:1
Entered: 1997-11-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


VAERS ID: 105293 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Oregon  
Vaccinated:1996-11-12
Onset:1996-11-12
   Days after vaccination:0
Submitted: 1997-11-24
   Days after onset:377
Entered: 1997-12-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 105295 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: North Carolina  
Vaccinated:1997-11-12
Onset:1997-11-14
   Days after vaccination:2
Submitted: 1997-11-24
   Days after onset:10
Entered: 1997-12-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Asphyxia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC Split Type:

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


VAERS ID: 105296 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1997-10-21
Onset:1997-11-01
   Days after vaccination:11
Submitted: 1997-11-24
   Days after onset:23
Entered: 1997-12-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC Split Type:

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


VAERS ID: 105297 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1997-09-08
Onset:1997-09-08
   Days after vaccination:0
Submitted: 1997-10-28
   Days after onset:50
Entered: 1997-12-02
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 447788 / UNK LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2352A / UNK RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1070 / UNK RL / -

Administered by: Private       Purchased by: Other
Symptoms: Cardiac arrest, Cyanosis, Dyspnoea, Encephalopathy, Infection, Pneumonia, Retinal haemorrhage, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-04
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever 104.0 all day;1AM 9SEp went to hosp for fever given motrin sent home;9SEP started coughing @ hosp;went to primary MD on 10SEP & was wheezing & coughing recvd albuterol tx in office;wheezed until 3OCT;redness & knots on legs p/vax


VAERS ID: 105298 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1997-11-17
Onset:1997-11-21
   Days after vaccination:4
Submitted: 1997-11-26
   Days after onset:5
Entered: 1997-12-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 444043 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0359E / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0768B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Renal failure, Urinary tract disorder, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA97012

Write-up: pt presented to hosp by mom on 21NOV97 5AM was DOA;coroner lists causes of death as renal failure, obstructive uropathy, & UTi;


VAERS ID: 105621 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Kentucky  
Vaccinated:1997-11-10
Onset:1997-11-10
   Days after vaccination:0
Submitted: 1997-11-11
   Days after onset:1
Entered: 1997-12-11
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 6C81349 / 2 RL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M195RF / 2 LL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER M0843 / 2 RL / -

Administered by: Public       Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Hypotension, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-11
   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: cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 12noon & returned to daycare;put down for nap 350Pm;checked on baby 415PM & not breathing resuscitated in local ER, transferred to another hosp;cont profoundly hypotensive w/severe metabolic acidosis & expired @ 0647 11NOV97;


VAERS ID: 105745 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1997-11-21
Onset:1997-11-22
   Days after vaccination:1
Submitted: 1997-12-11
   Days after onset:19
Entered: 1997-12-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC Split Type: MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


VAERS ID: 105871 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1997-10-06
Onset:1997-11-24
   Days after vaccination:49
Submitted: 1997-12-12
   Days after onset:18
Entered: 1997-12-26
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 812A2 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035PE / 1 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0938 / 1 LL / SC

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: 1997-11-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NONE-SIDS


VAERS ID: 106152 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1997-11-06
Onset:1997-11-06
   Days after vaccination:0
Submitted: 1997-12-04
   Days after onset:28
Entered: 1998-01-07
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978172 / UNK LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-06
   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: pt recv vax @ work place a/2:15;did not report any s/s of feeling ill either before or p/inj;lt for break 330PM & had MI during break;


VAERS ID: 106256 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Texas  
Vaccinated:1997-12-10
Onset:1997-12-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-12-19
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC Split Type: TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


VAERS ID: 106308 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1997-10-20
Onset:0000-00-00
Submitted: 1997-12-03
Entered: 1998-01-12
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20037KA / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Adrenal insufficiency, Asthenia, Coordination abnormal, Guillain-Barre syndrome, Hypertonia, Myasthenic syndrome, Neuropathy, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: grip strength 80-85%;thininning of muscle bulk to first dorsal interosseous muscle;thyroid nl;CPK nl;sed rate 50;total white count 7,800 w/H&H 12.9 & 39.1;rheumatoid factor neg;EKG nonspecific ST changes plus LAD:
CDC Split Type: MS97056

Write-up: pt exp worsening weakness x 2mo w/diff walking x2wk;pt exp joint stiffness;devel some numbness in hands & feet;pt noted to have flipped T waves in lateral chest leads;pt hosp;muscle weakness;GBS, ataxic;control dec;polyradiculoneuropathy;


VAERS ID: 106311 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:1997-12-18
Onset:1997-12-19
   Days after vaccination:1
Submitted: 1997-12-24
   Days after onset:5
Entered: 1998-01-12
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2357A2 / 2 LL / IM

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: 1997-12-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CA980003

Write-up: pt recv vax 18DEC97 & pt died of SIDS 19DEC97;


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