National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Found 8,467 cases where Patient Died

Case Details

This is page 14 out of 85

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


VAERS ID: 106325 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Missouri  
Vaccinated:1998-01-09
Onset:1998-01-11
   Days after vaccination:2
Submitted: 1998-01-12
   Days after onset:1
Entered: 1998-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91713 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0359 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: found dead in bed approx 06:00 11JAN98;


VAERS ID: 106323 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:1997-11-02
Onset:1997-11-06
   Days after vaccination:4
Submitted: 1998-01-07
   Days after onset:62
Entered: 1998-01-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypoxia, Paralysis
SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
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: Dilantin, decadron 9started in JUL post op brain surg)
Current Illness: glioblastoma
Preexisting Conditions: before dx glioblasma, excellent health before & ater;
Allergies:
Diagnostic Lab Data: several CT scans, MRI, blood work, etc;refused to test for GBS;
CDC Split Type:

Write-up: quadriplegia & 100% vent assisted;pt too weakened to cont w/chemotherapy;prognosis is less than 2mo;


VAERS ID: 106403 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:1997-10-13
Onset:1997-10-13
   Days after vaccination:0
Submitted: 1997-10-20
   Days after onset:7
Entered: 1998-01-15
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin;lasix;K-Dur;Allopurinol;
Current Illness: metastatic melanoma;
Preexisting Conditions: hx of CHF;metastatic melanoma;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt followed for metastatic melanoma recv flu vax & apparently had sudden death approx 45min later;no prev rxn to flu vax;


VAERS ID: 106427 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted: 1997-11-21
Entered: 1998-01-16
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 106654 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New York  
Vaccinated:1998-01-05
Onset:1998-01-18
   Days after vaccination:13
Submitted: 1998-01-19
   Days after onset:1
Entered: 1998-01-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1160E / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Dyspnoea, Encephalitis, Malaise, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-01-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: MD notified @ home from ER-parents heard pt gasp-pt having sz-pt taken to ER where died;


VAERS ID: 106657 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Tennessee  
Vaccinated:1997-12-08
Onset:1997-12-09
   Days after vaccination:1
Submitted: 1997-12-09
   Days after onset:0
Entered: 1998-01-20
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-12-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


VAERS ID: 106935 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Kentucky  
Vaccinated:1998-01-16
Onset:1998-01-17
   Days after vaccination:1
Submitted: 1998-01-23
   Days after onset:6
Entered: 1998-01-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: w/in 24hr SIDS per state;autopsy pending;


VAERS ID: 106939 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Unknown  
Location: Missouri  
Vaccinated:1968-02-02
Onset:1968-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Apnoea, Brain oedema, Coma, Convulsion, Malaise
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1968-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: day of vax pt was cranky & acted ill;next day 24hr later went unconscious for 8hr;pt brain swelled;pt died;


VAERS ID: 107005 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1998-01-13
Onset:1998-01-13
   Days after vaccination:0
Submitted: 1998-01-20
   Days after onset:7
Entered: 1998-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81441 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1238D / 2 RA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 441228 / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Risperdal;wellbutin
Current Illness: OM
Preexisting Conditions: NKDA;obesity, depression
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt reportedly collapsed @ home suddenly


VAERS ID: 107036 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:1998-01-15
Onset:1998-01-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1998-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / UNK LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 1563E / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1801E / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, CSF test abnormal, Convulsion, Coordination abnormal, Delirium, Hypokinesia, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-01-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: mild atopic dermatitis noted on 15JAN98
Allergies:
Diagnostic Lab Data: CSF showed 37WBC, 0RBC, repeat CSF p/sz WBC 140, RBC 90;
CDC Split Type: GA98003

Write-up: pt presented to ER w/refusal to walk, ataxia, devel sz;required intubation during hosp;CT scan cerebral edema, herniation, death;


VAERS ID: 107087 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1998-01-22
Onset:1998-01-23
   Days after vaccination:1
Submitted: 1998-01-23
   Days after onset:0
Entered: 1998-01-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


VAERS ID: 107132 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1998-01-05
Onset:1998-01-13
   Days after vaccination:8
Submitted: 1998-01-27
   Days after onset:14
Entered: 1998-02-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: awaiting coroner''s report
CDC Split Type:

Write-up: sudden death;


VAERS ID: 107361 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1996-10-31
Onset:1996-11-05
   Days after vaccination:5
Submitted: 1998-01-26
   Days after onset:447
Entered: 1998-02-10
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Coma, Diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


VAERS ID: 107414 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Ohio  
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted: 1998-02-02
Entered: 1998-02-11
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (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), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-05-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden agitation, screams, vomited frequently then died;


VAERS ID: 107712 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: New Mexico  
Vaccinated:1998-02-06
Onset:1998-02-07
   Days after vaccination:1
Submitted: 1998-02-09
   Days after onset:2
Entered: 1998-02-18
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-07
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


VAERS ID: 107742 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1998-01-22
Onset:1998-02-07
   Days after vaccination:16
Submitted: 1998-02-11
   Days after onset:4
Entered: 1998-02-19
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


VAERS ID: 107771 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:1997-10-31
Onset:1997-11-01
   Days after vaccination:1
Submitted: 1998-02-13
   Days after onset:104
Entered: 1998-02-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, crankiness, sleepless;


VAERS ID: 107790 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arizona  
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted: 1998-02-16
Entered: 1998-02-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt expired presumed SIDS 56hr p/vax;


VAERS ID: 107791 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1998-01-07
Onset:1998-01-12
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


VAERS ID: 108077 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Texas  
Vaccinated:1997-04-28
Onset:1997-04-28
   Days after vaccination:0
Submitted: 1997-05-09
   Days after onset:11
Entered: 1998-02-23
   Days after submission:290
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC Split Type: 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


VAERS ID: 107852 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1997-02-19
Onset:1997-03-01
   Days after vaccination:10
Submitted: 1998-02-23
   Days after onset:359
Entered: 1998-02-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Arrhythmia, Brain oedema, Cardiac arrest, Hepatic function abnormal, Hypoxia, Infection, Myocardial fibrosis, Myocarditis
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), 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), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98012678

Write-up: pt recv vax 24FEB97 & 1MAR97 pt died of a cardiac death;f/u was recv from MD:the autopsy showed myocardial fibrosis, so MD concluded the pt must have had a viral myocarditis;


VAERS ID: 107856 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:1997-10-15
Onset:1997-10-16
   Days after vaccination:1
Submitted: 1998-02-21
   Days after onset:128
Entered: 1998-02-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), 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, 39 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


VAERS ID: 108072 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New Mexico  
Vaccinated:1998-02-23
Onset:1998-02-25
   Days after vaccination:2
Submitted: 1998-03-02
   Days after onset:5
Entered: 1998-03-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC Split Type:

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


VAERS ID: 108124 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1998-03-06
Entered: 1998-03-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 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? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98021840

Write-up: pt recv vax & died from complication of varicella vax (date unk);


VAERS ID: 108127 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Jersey  
Vaccinated:1998-02-11
Onset:1998-02-15
   Days after vaccination:4
Submitted: 1998-02-27
   Days after onset:12
Entered: 1998-03-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Infection, Pyrexia, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC Split Type:

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


VAERS ID: 108536 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:1993-01-01
Onset:1997-01-01
   Days after vaccination:1461
Submitted: 1998-03-11
   Days after onset:434
Entered: 1998-03-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Blood alkaline phosphatase increased, Diarrhoea, Immunoglobulins increased, Jaundice, Malaise, Neoplasm malignant, Pancreatic disorder
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: 1997 serum alanine aminotrans approx 300;serum alk hos inc;serum hep a IgG an positive;serum hep B core a positive;serum hep B surface positive;total serum bilirubin nl
CDC Split Type: WAES97090116

Write-up: 1997 pt exp diarrhea, n, malaise & icterus;lab eval revealed transaminases in the 300"s, alk phos inc, positive for hep B surface antibodies;hep B core antigen positive, positive hep A imunoglobulin G antibody test;malaise;cancer pancreas


VAERS ID: 108668 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:1998-02-09
Onset:1998-02-10
   Days after vaccination:1
Submitted: 1998-03-13
   Days after onset:31
Entered: 1998-03-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military       Purchased by: Other
Symptoms: Agitation, Dyspnoea, Opisthotonus, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (narrow), 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: 1998-02-11
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pending
CDC Split Type:

Write-up: probable SIDS, died 11FEB98 approx 38hr p/vax;pt cried for a short time;APAP given & went to sleep;opistohonic w/resp distress;


VAERS ID: 108647 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1998-03-13
Onset:1998-03-14
   Days after vaccination:1
Submitted: 1998-03-16
   Days after onset:2
Entered: 1998-03-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Agranulocytosis (broad), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-14
   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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA980032

Write-up: pt died less than 24hr p/vax;


VAERS ID: 108655 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: North Carolina  
Vaccinated:1998-03-12
Onset:1998-03-13
   Days after vaccination:1
Submitted: 1998-03-16
   Days after onset:3
Entered: 1998-03-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome
SMQs:, Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Neonatal disorders (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-13
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


VAERS ID: 108656 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1998-02-27
Onset:1998-03-05
   Days after vaccination:6
Submitted: 1998-03-10
   Days after onset:5
Entered: 1998-03-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0907380 / 2 - / IM L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2500A2 / 2 - / IM L
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0915240 / 2 - / IM L
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 - / IM L

Administered by: Private       Purchased by: Private
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: 1998-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Respigam
Current Illness: NONE
Preexisting Conditions: prematurity-hx ROS/anemia
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt expired on 5MAR98 presented to ER in full C-R arrest;


VAERS ID: 108787 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: North Carolina  
Vaccinated:1998-01-28
Onset:1998-01-28
   Days after vaccination:0
Submitted: 1998-03-12
   Days after onset:43
Entered: 1998-03-23
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Brain oedema, Haemorrhage, Meningitis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Noninfectious meningitis (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-07
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient died;COD unk by reporter;


VAERS ID: 108794 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1997-05-29
Onset:1997-06-07
   Days after vaccination:9
Submitted: 1998-03-19
   Days after onset:285
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (narrow), Neonatal disorders (narrow), 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: 1997-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9733

Write-up: SIDS


VAERS ID: 108795 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: New Hampshire  
Vaccinated:1996-04-13
Onset:1996-04-28
   Days after vaccination:15
Submitted: 1998-03-19
   Days after onset:690
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1163A / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
SMQs:, Congenital, familial and genetic disorders (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9634

Write-up: SIDS


VAERS ID: 108796 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-01-02
Onset:1997-01-20
   Days after vaccination:18
Submitted: 1998-03-19
   Days after onset:423
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0165D / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Cyanosis, Eosinophilia, Jaundice, Sudden infant death syndrome, Unevaluable event
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: newborn
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9731

Write-up: SIDS;newborn jaundice tx w/phototherapy @ home;


VAERS ID: 108797 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-10-16
Onset:1997-11-10
   Days after vaccination:25
Submitted: 1998-03-19
   Days after onset:129
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

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: 1998-03-19
   Days after onset: 129
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


VAERS ID: 108799 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1998-03-17
Onset:1998-03-18
   Days after vaccination:1
Submitted: 1998-03-18
   Days after onset:0
Entered: 1998-03-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found deceased in crib this AM <24hr p/vax;


VAERS ID: 108923 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1997-10-06
Onset:1997-10-22
   Days after vaccination:16
Submitted: 1997-11-12
   Days after onset:21
Entered: 1998-03-26
   Days after submission:134
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978172 / 2 RA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 444071 / 1 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Asthenia, Chills, Condition aggravated, Constipation, Cough, Diarrhoea, Dizziness, Dyspepsia, Dyspnoea, Fatigue, Feeling cold, Headache, Influenza, Influenza like illness, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-31
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide-water pill
Current Illness: NONE
Preexisting Conditions: HTN, dizziness;
Allergies:
Diagnostic Lab Data: 2wk later on 22OCT97 felt resp diff breathing merthiolate, thimerosal rxn;
CDC Split Type:

Write-up: extreme fatigue, muscles/joint pain, h/a, gastrointestinal upset, constipation, diarrhea, chills-feeling cold, dry cough, fever;22OCT97 exp extreme diff breathing & dizziness;pt felt had the flu;. All these symptoms started on Oct 6, 1997 when the influenza, pneumococcal vaccines were administered. Her health continued to deteriorate and on Oct 22, 1997 in the evening she experienced extreme difficulty breathing and then later dizziness. At this point she was taken to the Emergency room of hospital. Felt nauseated at home- threw up at hospital. Asthenia, headache, diarrhea, no dyspnea, myalgia, dyspepsia, chills fever, flu symd, arthralgia, constipation, cough inc, reaction aggrav.


VAERS ID: 108976 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Hampshire  
Vaccinated:1996-09-23
Onset:1996-10-27
   Days after vaccination:34
Submitted: 1998-03-29
   Days after onset:518
Entered: 1998-03-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 01650 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9635

Write-up: SIDS


VAERS ID: 108977 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-01-08
Onset:1997-01-22
   Days after vaccination:14
Submitted: 1998-03-01
   Days after onset:403
Entered: 1998-03-31
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH97

Write-up: undetermined cause of death;


VAERS ID: 109026 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted: 1998-03-24
Entered: 1998-04-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-04-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9636

Write-up: SIDS


VAERS ID: 109027 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New Hampshire  
Vaccinated:1997-07-09
Onset:1997-07-23
   Days after vaccination:14
Submitted: 1998-03-23
   Days after onset:243
Entered: 1998-04-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0199E / 2 LL / -

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: 1997-07-23
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9734

Write-up: SIDS


VAERS ID: 109218 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1998-01-23
Onset:1998-01-23
   Days after vaccination:0
Submitted: 1998-02-20
   Days after onset:28
Entered: 1998-04-03
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


VAERS ID: 109219 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1998-01-28
Onset:1998-01-29
   Days after vaccination:1
Submitted: 1998-01-30
   Days after onset:1
Entered: 1998-04-03
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


VAERS ID: 109562 (history)  
Form: Version 1.0  
Age: 0.58  
Sex: Male  
Location: Unknown  
Vaccinated:1998-02-19
Onset:1998-02-20
   Days after vaccination:1
Submitted: 1998-03-30
   Days after onset:38
Entered: 1998-04-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 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: 1998-02-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


VAERS ID: 109861 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1998-04-14
Onset:1998-04-14
   Days after vaccination:0
Submitted: 1998-04-15
   Days after onset:1
Entered: 1998-04-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


VAERS ID: 109867 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Iowa  
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted: 1998-04-16
Entered: 1998-04-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

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: 1998-04-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC Split Type: IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


VAERS ID: 110009 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1998-03-26
Onset:1998-03-27
   Days after vaccination:1
Submitted: 1998-04-16
   Days after onset:19
Entered: 1998-04-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RA / SC

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: 1998-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: +suspected sepsis @ birth treated x 7 days
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recv vax 26MAR98 & died 27MAR98;


VAERS ID: 110237 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Nevada  
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted: 1998-04-20
Entered: 1998-04-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-17
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 expired @ 10PM (cause) pending autopsy report;


VAERS ID: 110238 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1998-04-20
Onset:1998-04-21
   Days after vaccination:1
Submitted: 1998-04-21
   Days after onset:0
Entered: 1998-04-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / SC

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: 1998-04-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


VAERS ID: 110547 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:1998-04-07
Onset:1998-04-07
   Days after vaccination:0
Submitted: 1998-04-08
   Days after onset:1
Entered: 1998-05-04
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-07
   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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


VAERS ID: 110675 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: California  
Vaccinated:1998-03-24
Onset:1998-04-04
   Days after vaccination:11
Submitted: 1998-05-06
   Days after onset:31
Entered: 1998-05-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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: 1998-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC Split Type:

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


VAERS ID: 110683 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1998-04-16
Onset:1998-04-22
   Days after vaccination:6
Submitted: 1998-04-27
   Days after onset:5
Entered: 1998-05-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type: NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


VAERS ID: 110712 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-01-15
Onset:1998-01-30
   Days after vaccination:15
Submitted: 1998-05-05
   Days after onset:94
Entered: 1998-05-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (TDVAX) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Condition aggravated, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC Split Type:

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


VAERS ID: 111280 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1998-03-24
Onset:1998-04-01
   Days after vaccination:8
Submitted: 1998-04-02
   Days after onset:1
Entered: 1998-06-01
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event
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: 1998-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


VAERS ID: 111281 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Oregon  
Vaccinated:1998-02-17
Onset:1998-02-26
   Days after vaccination:9
Submitted: 1998-03-18
   Days after onset:20
Entered: 1998-06-01
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / SC

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: 1998-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


VAERS ID: 111282 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alabama  
Vaccinated:1998-05-14
Onset:1998-05-19
   Days after vaccination:5
Submitted: 1998-05-20
   Days after onset:1
Entered: 1998-06-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

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: 1998-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


VAERS ID: 111499 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:1997-05-13
Onset:1997-05-24
   Days after vaccination:11
Submitted: 1998-06-05
   Days after onset:377
Entered: 1998-06-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other       Purchased by: Other
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-24
   Days after onset: 365
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


VAERS ID: 111504 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:1998-05-18
Onset:1998-05-19
   Days after vaccination:1
Submitted: 1998-06-02
   Days after onset:14
Entered: 1998-06-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451497 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2420A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 44779D / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1351 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Atelectasis, Cardiac arrest, Lung disorder, Pneumothorax
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), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: mild URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to ER in full arrest p/a nap 19MAY98 1 day p/vax;


VAERS ID: 111826 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:1998-05-19
Onset:1998-05-23
   Days after vaccination:4
Submitted: 1998-06-09
   Days after onset:17
Entered: 1998-06-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad), 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, 21 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


VAERS ID: 111830 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1998-03-11
Onset:1998-03-12
   Days after vaccination:1
Submitted: 1998-04-24
   Days after onset:42
Entered: 1998-06-15
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 1 - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0002H / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12942 / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: hepatitis B 1st dose @ hosp 1JAN98
Current Illness: NONE
Preexisting Conditions: reflux GE
Allergies:
Diagnostic Lab Data: cult from autopsy were negative grade II reflux UGI x-ray done on 22JAN98 positive results;
CDC Split Type: WI98020

Write-up: died of SIDS COD per autopsy report 30MAR98;pt recv vax 11MAR98;


VAERS ID: 111980 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1998-05-11
Onset:1998-05-15
   Days after vaccination:4
Submitted: 1998-06-04
   Days after onset:20
Entered: 1998-06-19
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC Split Type:

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


VAERS ID: 112005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arkansas  
Vaccinated:1998-05-13
Onset:1998-05-31
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-31
   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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC Split Type: AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


VAERS ID: 112192 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1998-03-12
Onset:1998-03-14
   Days after vaccination:2
Submitted: 1998-05-01
   Days after onset:47
Entered: 1998-06-26
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0571E / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1070 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-14
   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: unk
Current Illness: NONE
Preexisting Conditions: NONE-rash on face-oily-probably secondary to immature sweat gland
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS98008

Write-up: mom states tried to wake pt 14MAR98 but pt did not wake up;pt okay when went to sleep;


VAERS ID: 112250 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New York  
Vaccinated:1998-06-15
Onset:1998-06-16
   Days after vaccination:1
Submitted: 1998-06-23
   Days after onset:7
Entered: 1998-07-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2587A2 / 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: 1998-06-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: well child
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS 16JUN98 <24hr p/vax;autopsy performed @ medical examiners p/transport from hosp;


VAERS ID: 112251 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:1998-05-05
Onset:1998-05-06
   Days after vaccination:1
Submitted: 1998-06-23
   Days after onset:48
Entered: 1998-07-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 420629 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 45190 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0212 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dimetapp;pt recv HBV 22MAR98;
Current Illness: Trismy 5, nasal congestion
Preexisting Conditions: Trisomy 5;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt reported by mom to have turned blue in car seat p/coming from hosp visit;911 called CPR done pt was taken to hosp;


VAERS ID: 112335 (history)  
Form: Version 1.0  
Age: 38.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1998-04-27
Onset:1998-05-04
   Days after vaccination:7
Submitted: 1998-06-25
   Days after onset:52
Entered: 1998-07-06
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0052H / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Arteriosclerosis, Brain oedema, Cardiac arrest, Coronary artery disease, Myocardial ischaemia
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), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: varicella IGG teston 25APR98 was negative;
CDC Split Type:

Write-up: pt exposed to chickenpox 12wk prior to first visit;varicella IGG test was negative 25APR98;pt recv vax 27APR98 no subsequent sx;pt was found lifeless on 4MAY98 while taking a nap;autopsy was performed;


VAERS ID: 112402 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:1998-03-19
Onset:1998-03-25
   Days after vaccination:6
Submitted: 1998-04-06
   Days after onset:11
Entered: 1998-07-08
   Days after submission:93
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died of SIDS 1 day p/vax;pt recv vax 19AMR98 per mom & MD office;


VAERS ID: 112467 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: California  
Vaccinated:1998-04-22
Onset:1998-04-23
   Days after vaccination:1
Submitted: 1998-07-09
   Days after onset:77
Entered: 1998-07-13
   Days after submission:4
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: Other
Symptoms: Agitation, Chills, Constipation, Crying, Diarrhoea, Injection site hypersensitivity, Injection site oedema, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-26
   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: APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: w/in 7hr site of inj was swollen & reddish for next 12hr pt alternately screamed inconsolably & fell into a deep sleep, next day had diarrhea & tool longer to finish bottles, as day went by skin felt cold to touch;pt later died;constipation


VAERS ID: 112660 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Washington  
Vaccinated:1998-06-01
Onset:1998-06-04
   Days after vaccination:3
Submitted: 1998-07-13
   Days after onset:39
Entered: 1998-07-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 7G81489 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7L91652 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1070 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-20
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy was done & findings to explain death;probably SIDS;
CDC Split Type:

Write-up: pt recv vax 1JUN98 & pt had gastroenteritis on 4JUN98 which resolved;gastroenteritis reoccurred on 19JUN98;pt died of SIDS on 20JUN98;


VAERS ID: 112811 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1998-07-10
Onset:1998-07-11
   Days after vaccination:1
Submitted: 1998-07-14
   Days after onset:3
Entered: 1998-07-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia
SMQs:, Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Congenital, familial and genetic disorders (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-07-11
   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: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC Split Type:

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


VAERS ID: 112819 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Michigan  
Vaccinated:1998-07-06
Onset:1998-07-13
   Days after vaccination:7
Submitted: 1998-07-20
   Days after onset:7
Entered: 1998-07-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


VAERS ID: 112938 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: New Jersey  
Vaccinated:1997-11-05
Onset:1998-01-02
   Days after vaccination:58
Submitted: 1998-07-23
   Days after onset:201
Entered: 1998-07-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-02
   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: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


VAERS ID: 112990 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Missouri  
Vaccinated:1998-07-01
Onset:1998-07-11
   Days after vaccination:10
Submitted: 1998-07-15
   Days after onset:4
Entered: 1998-08-03
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 - / -

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Cyanosis, Malaise, Meningitis, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO98039

Write-up: 11JUL98 pt began running fever & vomited once;mom gave APAP & fever went down;12JUL98 pt was sick & fussy in morning;by noon, pt had hands & lips turning blue;went to ER:13JUL98 pt died of meningococcal meningitis;


VAERS ID: 113301 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1998-04-22
Onset:1998-04-25
   Days after vaccination:3
Submitted: 1998-07-01
   Days after onset:67
Entered: 1998-08-10
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC Split Type:

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


VAERS ID: 113383 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1980-05-01
Onset:1980-05-04
   Days after vaccination:3
Submitted: 1998-08-10
   Days after onset:6672
Entered: 1998-08-12
   Days after submission:2
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: Military       Purchased by: Military
Symptoms: Unevaluable event
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1980-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


VAERS ID: 113404 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1998-08-07
Onset:1998-08-08
   Days after vaccination:1
Submitted: 1998-08-09
   Days after onset:1
Entered: 1998-08-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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: 1998-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC Split Type:

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


VAERS ID: 113425 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1998-07-23
Onset:1998-07-25
   Days after vaccination:2
Submitted: 1998-08-07
   Days after onset:13
Entered: 1998-08-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC Split Type:

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


VAERS ID: 113437 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1998-06-05
Onset:1998-06-07
   Days after vaccination:2
Submitted: 1998-08-12
   Days after onset:66
Entered: 1998-08-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


VAERS ID: 113440 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1998-07-21
Onset:1998-07-22
   Days after vaccination:1
Submitted: 1998-07-24
   Days after onset:2
Entered: 1998-08-17
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 LL / SC

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: 1998-07-22
   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:
CDC Split Type: OH98051

Write-up: SIDS;


VAERS ID: 113477 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: American Samoa  
Vaccinated:1998-07-29
Onset:1998-07-29
   Days after vaccination:0
Submitted: 1998-08-03
   Days after onset:5
Entered: 1998-08-18
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-30
   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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC Split Type:

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


VAERS ID: 113478 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-11-24
Onset:1997-12-26
   Days after vaccination:32
Submitted: 1998-08-01
   Days after onset:217
Entered: 1998-08-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-12-26
   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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH97

Write-up: SIDS;


VAERS ID: 113661 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Unknown  
Vaccinated:1998-05-11
Onset:1998-05-16
   Days after vaccination:5
Submitted: 1998-08-24
   Days after onset:100
Entered: 1998-08-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Condition aggravated, Hepatitis, Hypersensitivity, Hypertonia, Meningitis, Vomiting
SMQs:, Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: antimicrobial therapy
Current Illness:
Preexisting Conditions: otitis med;upper resp infect
Allergies:
Diagnostic Lab Data: autopsy eosinophils around cardiac vessles;autopsy no viral inclusions in liver;only frontal lobe specimen pos for wild type VZV on PCR analysis;heart & cerebellum high ELISA''s
CDC Split Type: WAES98070287

Write-up: 4 days post vax pt died;mom described child as fussy 15MAY98 w/n/v then becoming rigid in arms & legs;COD originally believe to be myocarditis now feel meningitis;sz, noted hepatitis w/multifocal inflam;allerg react;


VAERS ID: 113717 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1998-05-20
Onset:1998-05-26
   Days after vaccination:6
Submitted: 1998-06-02
   Days after onset:7
Entered: 1998-08-31
   Days after submission:90
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hepatic failure
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC Split Type: TN98027

Write-up: liver failure


VAERS ID: 113718 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1998-07-15
Onset:1998-07-15
   Days after vaccination:0
Submitted: 1998-08-27
   Days after onset:43
Entered: 1998-08-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-19
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


VAERS ID: 113721 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Jersey  
Vaccinated:1998-08-14
Onset:1998-08-23
   Days after vaccination:9
Submitted: 1998-08-26
   Days after onset:3
Entered: 1998-08-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 934790 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 2699H2 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0492 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;pathology/tissue report pending;
CDC Split Type:

Write-up: pt found lifeless in bed;head reported to have been wedged between mattress & wall;


VAERS ID: 113727 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1998-08-21
Entered: 1998-08-31
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


VAERS ID: 113800 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Missouri  
Vaccinated:1998-07-25
Onset:1998-07-29
   Days after vaccination:4
Submitted: 1998-08-04
   Days after onset:6
Entered: 1998-09-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: variety done on post mortem exam;some still pending;
CDC Split Type: MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


VAERS ID: 113911 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1997-07-01
Onset:1997-08-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Gastrointestinal carcinoma
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-11
   Days after onset: 71
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zocar
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax DEC96 & JUL97 blood work in MAR showed no sign of disease;cancer of colon w/advanced metastases to liver detected in AUG because of rapid onset, want this on record;


VAERS ID: 113915 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Minnesota  
Vaccinated:1998-09-03
Onset:1998-09-03
   Days after vaccination:0
Submitted: 1998-09-03
   Days after onset:0
Entered: 1998-09-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly
SMQs:, Cardiac failure (narrow), Congenital, familial and genetic disorders (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


VAERS ID: 113916 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alaska  
Vaccinated:1998-07-27
Onset:1998-08-13
   Days after vaccination:17
Submitted: 1998-08-14
   Days after onset:1
Entered: 1998-09-08
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC Split Type: AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


VAERS ID: 114109 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Idaho  
Vaccinated:1998-06-16
Onset:1998-06-24
   Days after vaccination:8
Submitted: 1998-08-27
   Days after onset:64
Entered: 1998-09-14
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC Split Type: ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


VAERS ID: 114230 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Arkansas  
Vaccinated:1998-09-10
Onset:1998-09-10
   Days after vaccination:0
Submitted: 1998-09-11
   Days after onset:1
Entered: 1998-09-21
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 2 RL / SC

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: 1998-09-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


VAERS ID: 114283 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1998-09-17
Entered: 1998-09-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Infection, Laboratory test abnormal, Lung disorder, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
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: unk
Current Illness:
Preexisting Conditions: human immunodeficiency virus infection
Allergies:
Diagnostic Lab Data: CXR parenchymal nodules;diagnostic microbiology cytopathic changes characteristic of measles infect;physical exam basilar pulmonary rales;pulmonary biopsy numerous multinucleated giant cells;
CDC Split Type: WAES98090695

Write-up: vaccine associated measles pneumonitis in adult w/AIDS;approx 1yr p/vax pt w/cough, dyspnea & fever;exam revealed pulmonary rales & chest x-ray showed parenchymal nodules;analysis of lung biopsy showed multinucleated giant cells;


VAERS ID: 114427 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New York  
Vaccinated:1998-09-15
Onset:1998-09-16
   Days after vaccination:1
Submitted: 1998-09-16
   Days after onset:0
Entered: 1998-09-28
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0984H / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy report pending
CDC Split Type:

Write-up: pt recv vax 15SEP98 pt died of presumptive sudden infant death synd following morning 16SEP98;


VAERS ID: 114917 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Washington  
Vaccinated:1997-09-15
Onset:1997-09-21
   Days after vaccination:6
Submitted: 1998-10-05
   Days after onset:379
Entered: 1998-10-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 445540 / UNK LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0359E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769B / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-09-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac susp
Current Illness: gastroesophageal reflux
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 16SEP97 - SIDS on 21SEP97;parents requested VAERS on 22SEP98-1yr anniversary of pt death;


VAERS ID: 114918 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Connecticut  
Vaccinated:1998-09-11
Onset:1998-09-30
   Days after vaccination:19
Submitted: 1998-10-07
   Days after onset:7
Entered: 1998-10-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 447788 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: apparent SIDS 30SEP98 final autopsy pending;


VAERS ID: 114925 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1998-09-23
Onset:1998-09-25
   Days after vaccination:2
Submitted: 1998-10-07
   Days after onset:12
Entered: 1998-10-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453844 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RK / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N10351 / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Anaemia, Apnoea, Cardiac arrest, Dyspnoea, Gaze palsy, Laboratory test abnormal, Respiratory alkalosis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (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), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Ocular motility disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-26
   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: NONE
Preexisting Conditions: NONE but was 36wk SGA infant
Allergies:
Diagnostic Lab Data: hgb 3.0;bld PH 6.5;NA140;cl 113;plts 91;K+ 7.0;co2 6.5;
CDC Split Type:

Write-up: pt recv vax 23SEP98 & was fussy 25SEP98;26SEP98 early hr of AM pt noted to be gasping w/eyes deviated;unsuccessful full resuscitation on immed arrival @ ER;pt was in cardiorespiratory arrest;


VAERS ID: 114975 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1998-10-07
Onset:1998-10-08
   Days after vaccination:1
Submitted: 1998-10-08
   Days after onset:0
Entered: 1998-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-10-08
   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: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


VAERS ID: 115054 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-10-08
Onset:1998-10-08
   Days after vaccination:0
Submitted: 1998-10-14
   Days after onset:6
Entered: 1998-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800624

Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;


VAERS ID: 115255 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1998-10-13
Onset:1998-10-14
   Days after vaccination:1
Submitted: 1998-10-20
   Days after onset:6
Entered: 1998-10-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981800 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800667

Write-up: pt recv vax 13OCT98 & 14OCT98 pt committed suicide gun shot wound to head;


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

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=14&PERPAGE=100&DIED=Yes


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