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VAERS ID: 115260 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-10-21
Onset:1998-10-22
   Days after vaccination:1
Submitted: 1998-10-23
   Days after onset:1
Entered: 1998-10-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC Split Type:

Write-up: c/o vague sx of not feeling well;T102.4;


VAERS ID: 115261 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-10-20
   Days after onset:1
Entered: 1998-10-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451500 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0438H / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0079H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0292 / 1 RL / -

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: 1998-10-19
   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: pt recv hep b vax @ birth;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: infant died of possible SIDS 4-5hr p/vax;


VAERS ID: 115514 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-10-21
   Days after onset:2
Entered: 1998-11-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-19
   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: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


VAERS ID: 115534 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Jersey  
Vaccinated:1996-11-05
Onset:1996-11-27
   Days after vaccination:22
Submitted: 1998-04-30
   Days after onset:518
Entered: 1998-11-02
   Days after submission:186
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Crying, Infection, Lung disorder, Pneumonia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt sister recv DTA vax 11/28-2.5 mo-#1 dose-NO EVENT NOTED~ ()~~~In Sibling
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt recv vax on 11/5/96; subsequently pt exp uncontrollable crying x2hr for 2 wk; tx=Tylenol.


VAERS ID: 115695 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1998-10-01
Onset:1998-10-01
   Days after vaccination:0
Submitted: 1998-11-01
   Days after onset:31
Entered: 1998-11-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20188HE / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ?cardiac disorder
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MPI981933

Write-up: pt recv vax & died 10hr post vax;date of vax not specified, but batch number quoted is a current season''s batch;


VAERS ID: 115698 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Illinois  
Vaccinated:1998-10-06
Onset:1998-10-08
   Days after vaccination:2
Submitted: 1998-10-14
   Days after onset:6
Entered: 1998-11-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2607A2 / 2 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Ascites, Atrial septal defect, Haemothorax, Pulmonary oedema, Respiratory disorder, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL98074

Write-up: pt recv vax 6OCT98 & preliminary dx SIDS;


VAERS ID: 115709 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Michigan  
Vaccinated:1998-05-27
Onset:1998-05-30
   Days after vaccination:3
Submitted: 1998-10-23
   Days after onset:146
Entered: 1998-11-04
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272E / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1352 / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiovascular disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: healthy exam 27MAY98
Preexisting Conditions: tetralogy of fallot, complicated;rt aortic arch
Allergies:
Diagnostic Lab Data: 24JAN98 echocardiogram EKG 20JAN98, 26FEB98, 19MAR98, 28APR98;
CDC Split Type:

Write-up: father got up @ 3-4Am for work, child fine, given formula;mom woke @ 530, child dead;autopsy report not recv as to 23OCT98;heart disease felt to be significant probable cause of death;


VAERS ID: 115910 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: Virginia  
Vaccinated:1998-10-29
Onset:1998-10-29
   Days after vaccination:0
Submitted: 1998-11-04
   Days after onset:6
Entered: 1998-11-06
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


VAERS ID: 115912 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:1998-10-28
Onset:1998-10-28
   Days after vaccination:0
Submitted: 1998-10-30
   Days after onset:2
Entered: 1998-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 02298P / UNK RA / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Chest pain
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: FLU89161098

Write-up: pt recv vax 28OCT98 4PM;taken to Er @ approx 6Pm w/sudden onset of chest discomfort;


VAERS ID: 115913 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Female  
Location: Missouri  
Vaccinated:1998-10-28
Onset:1998-10-28
   Days after vaccination:0
Submitted: 1998-10-30
   Days after onset:2
Entered: 1998-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 021198P / 2 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Malaise, Myocarditis, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions: allergic to PCN
Allergies:
Diagnostic Lab Data: drug toxicology drawn in ER;
CDC Split Type: FLU89171098

Write-up: pt recv vax 6-8AM & on 28OCT98 pt vomited 10min later felt bad;went home & cont c/o not feeling well next day;drove husband to work & when arrived in parking lot lost consciousness & stopped breathing;


VAERS ID: 116127 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: New York  
Vaccinated:1998-09-29
Onset:1998-09-30
   Days after vaccination:1
Submitted: 1998-11-06
   Days after onset:37
Entered: 1998-11-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988207 / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Blood amylase increased, Infection, Laboratory test abnormal, Pancreatitis haemorrhagic, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-01
   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: Stavudine;Videx liquid
Current Illness:
Preexisting Conditions: cogenital HIV+ from mother @ birth;never developed AIDS fefining illness;NKDA;followed by immunologist;
Allergies:
Diagnostic Lab Data: SEP98 CD4 count 1400 & viral load test of approx 8000;amylase 2125;blood lipase $g8000;autopsy included extensive microscopic studies;tissue stains yielded no organisms;brain examined by neuropathologist & found to be free of any AIDS;
CDC Split Type:

Write-up: 30SEP98 exp malaise, abd complaints, sleepiness;taken to ER dx benign rxn to flu vax;taken home later devel vomiting;mom found child unresponsive taken back to ER;child pronounced in ER;autopsy had acute hemorrhagic pancreatitis;


VAERS ID: 116344 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1998-11-02
Onset:1998-11-07
   Days after vaccination:5
Submitted: 1998-11-09
   Days after onset:2
Entered: 1998-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0936780 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1370E / 3 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0935770 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0514H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 455656 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: MS98026

Write-up: 7NOV98 respiratory arrest taken to hosp;no prior problems noted-child was nl & appeared healthy day of vax;no prev events noted;


VAERS ID: 116465 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-25
   Days after vaccination:9
Submitted: 1998-11-12
   Days after onset:18
Entered: 1998-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20228KC / 1 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 455382 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Accolate, Aerobid, albuterol, Isonizid, Zoloft, Pyridoxine, Ritalin, Theophyline;
Current Illness: COPD, ASHD, CHF, HTN, resp failure, PRD
Preexisting Conditions: NKA;COPD, ASHD, CHF, HTN, resp failure, PRD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: no immed rxn, no adverse rxn @ site;no elevated pulse, temp;


VAERS ID: 116466 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Ohio  
Vaccinated:1998-10-14
Onset:1998-10-20
   Days after vaccination:6
Submitted: 1998-11-12
   Days after onset:23
Entered: 1998-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20228KC / 1 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 454382 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zestril, Norvasc, Lasix, Ritalin, Pepcid, ensure per tube
Current Illness: CVA, CHF, NIDDM, ASHD, HTN, VHD, CAF, PVD, renal insufficiency, COPD
Preexisting Conditions: PCN, cephalosporins;CVA, NIDDM, ASHD, HTN, VHD, CAF, PVD, renal insufficiency, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: no immediate rxn, no adverse rxn @ site, no acute distress resident found w/no BP, no pulse initiated CPR;


VAERS ID: 116533 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1998-10-21
Onset:1998-11-05
   Days after vaccination:15
Submitted: 1998-11-10
   Days after onset:5
Entered: 1998-11-19
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0738H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS98028

Write-up: pt had no know hlth problems;recv 2mo vax only local rxn of redness, swelling lt thigh which subsided;only sl fever p/inj relieved per mom w/APAP;was found dead 2wk later local daycare;CPR performed;autopsy revealed pt died of SIDS;


VAERS ID: 116613 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Ohio  
Vaccinated:1998-09-17
Onset:1998-09-23
   Days after vaccination:6
Submitted: 1998-11-06
   Days after onset:44
Entered: 1998-11-23
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Cardiac arrest, Cardiovascular disorder, Infection, Sepsis
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), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC Split Type: OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


VAERS ID: 116616 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Vermont  
Vaccinated:1998-10-07
Onset:1998-10-16
   Days after vaccination:9
Submitted: 1998-11-16
   Days after onset:31
Entered: 1998-11-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785H / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0644H / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hydronephrosis, Hypoxia, Pericardial effusion, Pulmonary oedema, Renal impairment, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: adopted child-birth parents siblings;hydronephrosis & renal insuff on autopsy
Allergies:
Diagnostic Lab Data: autopsy unrevealing of COD
CDC Split Type:

Write-up: unexplained infant death;autopsy finding of hydronephrosis & renal insufficiency not felt to be r/t pt death;


VAERS ID: 116744 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:1998-10-20
Onset:0000-00-00
Submitted: 1998-10-27
Entered: 1998-11-24
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK RA / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0924000 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Stupor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: schizophrenia;pt brother states pt stated had been advised to have heart surgery;
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX98164

Write-up: arrived @ ER via ambulance CPR in progress reported unconscious, unresponsive by family who called ambulance;CPR discontinued 815AM;no post mortem exam done;


VAERS ID: 116801 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-11-09
   Days after onset:23
Entered: 1998-11-25
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0978660 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Coronary artery disease, Diabetes mellitus, Unevaluable event
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Other ischaemic heart disease (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec, lanoxin, coumadin, immodium PRN;insulin
Current Illness: NONE
Preexisting Conditions: CAD/diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: NJ9827

Write-up: pt expired w/in 24h of vax;no apparent allergic response;


VAERS ID: 116802 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1998-11-18
Onset:1998-11-20
   Days after vaccination:2
Submitted: 1998-11-23
   Days after onset:3
Entered: 1998-11-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 860A2 / UNK - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0982730 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 794F3 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dimetapp
Current Illness: slight cold - cough, congestion, diarrhea
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800824

Write-up: pt recv vax 18NOV98 & 20NOV98 pt died (SIDS);


VAERS ID: 116883 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: California  
Vaccinated:1998-04-24
Onset:1998-04-28
   Days after vaccination:4
Submitted: 1998-11-02
   Days after onset:188
Entered: 1998-11-27
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0927950 / 1 - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0927950 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0026H / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Bradycardia, Cyanosis, Dehydration, Diarrhoea, Lung disorder, Pulmonary oedema, Shock, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-30
   Days after onset: 2
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 revealed dehydration w/moderate WBC''s in CSF;
CDC Split Type:

Write-up: child devel gastroenteritis 4 days p/vax; probably unrelated-devel worsening emesis & diarrhea over 2 days;despite intervention, pt subsequently went into shock & was taken to ER blue & pulseless;


VAERS ID: 117068 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Male  
Location: California  
Vaccinated:1998-11-13
Onset:1998-11-14
   Days after vaccination:1
Submitted: 1998-11-16
   Days after onset:2
Entered: 1998-12-04
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 7+ - / -

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Dyspnoea, Lung disorder, Right ventricular failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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 (narrow), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE frail-depressed
Preexisting Conditions: 18OCT98 resp infect-sx free 28OCT98
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COPD w/exacerbation;resp distress;expired 15NOV98 @ hosp;adm to hosp 14NOV98;


VAERS ID: 117373 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Female  
Location: New York  
Vaccinated:1998-10-20
Onset:1998-10-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1998-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Headache, Infection, Lymphadenopathy, Neck pain, Nephrolithiasis, Pyrexia, Shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-31
   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:
Current Illness:
Preexisting Conditions: allerg to Imipenem, ALL, Bone Marrow Transplant, s/p host vs graft disease
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt expired of septic shock 2 days post vax;this report being filed as a precaution;vaccine not believed to result in septic shock;


VAERS ID: 117423 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Ohio  
Vaccinated:1998-11-30
Onset:1998-12-02
   Days after vaccination:2
Submitted: 1998-12-10
   Days after onset:8
Entered: 1998-12-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1091H / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died while sleeping of apparent SIDS approx 40hr p/vax;


VAERS ID: 117475 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1998-10-24
Onset:1998-11-18
   Days after vaccination:25
Submitted: 1998-12-04
   Days after onset:16
Entered: 1998-12-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1559E / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Oral candidiasis, Sudden infant death syndrome, Unevaluable event
SMQs:, Oropharyngeal infections (narrow), Neonatal disorders (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: achondroplasia, syndactyly
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9820

Write-up: SIDS 18NOV98;seen on 6NOV98 had physical exam;had oral thrush put on nystatin;


VAERS ID: 117527 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:1998-09-11
Onset:1998-09-24
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1998-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cachexia, Condition aggravated, Diarrhoea, Dyspepsia, Dyspnoea, Hypotension, Hypothermia, Lung disorder, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Accidents and injuries (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-20
   Days after onset: 57
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur;Pred;Xanas;Azmacort;Synthroid;Aldactone;Lasix;KDUR;albuterol;atrovent;loxanol;
Current Illness: no acute illness afeb;end state COPD;
Preexisting Conditions: End Stage COPD; corpulmonale;HTN;Heart Failure
Allergies:
Diagnostic Lab Data: BP 104/70;T97.9;pulse 96;resp 20;
CDC Split Type:

Write-up: pt exp diarrhea 24SEp;8hr later upset stomach;7hr later dyspnea;


VAERS ID: 117599 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Maryland  
Vaccinated:1998-09-25
Onset:1998-10-05
   Days after vaccination:10
Submitted: 1998-12-07
   Days after onset:63
Entered: 1998-12-22
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0944770 / 3 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0973960 / 3 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0597 / 3 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Depressed level of consciousness, Hypotonia, Myelitis, Oedema, Quadriplegia, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-14
   Days after onset: 101
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 25SEP98 & 5OCT vomiting & flacid quadraplegia spinal cord swelling tx w/5 days of steroids then 3wk wean 5 days IVIG. Per annual followup pt passed away from complications from myliatis resulting from the hepatitis B vaccine.


VAERS ID: 117760 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Washington  
Vaccinated:1998-07-28
Onset:1998-08-26
   Days after vaccination:29
Submitted: 1998-12-21
   Days after onset:117
Entered: 1998-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 1 RA / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Cerebral infarction, Delirium, Petechiae, Renal impairment, Sudden infant death syndrome, Unevaluable event
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Neonatal disorders (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: umbilical hernia
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES98121170

Write-up: Pt recv vax on 7/28/98; on 8/26/98 pt exp SIDS


VAERS ID: 117840 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New Jersey  
Vaccinated:1998-10-28
Onset:1998-11-02
   Days after vaccination:5
Submitted: 1998-12-18
   Days after onset:46
Entered: 1998-12-31
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 2 LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 361453A / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0597 / 2 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated, Diarrhoea, Hepatic neoplasm, Hypertonia, Hypotonia, Pyrexia, Skin odour abnormal, Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow), Liver tumours of unspecified malignancy (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp diarrhea, sweating @ 2mo w/DTP dose 1;~ ()~~~In patient
Other Medications: APAP on 28OCT98
Current Illness: sniffles, cough
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 28OCT98 & exp sl fever, stretching, stiffening, cough, sniffles, very loose bowel movements, vomiting, odor on head;


VAERS ID: 117867 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:1998-11-27
Onset:1998-12-08
   Days after vaccination:11
Submitted: 1998-12-30
   Days after onset:22
Entered: 1999-01-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 939790 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361503A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0498 / 1 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: 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: 1998-12-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: death-found in crib cyanotic;


VAERS ID: 117906 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: Utah  
Vaccinated:1998-11-30
Onset:1998-12-01
   Days after vaccination:1
Submitted: 1998-12-23
   Days after onset:22
Entered: 1999-01-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 498819 / UNK LA / -

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Pyrexia, Shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-02
   Days after onset: 1
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: Cordarone
Current Illness: NONE
Preexisting Conditions: Allergic to PCN, Irregular heart beat, ventricular arrhythmia(declined implantable defibrillator, CABG x3 in 1995, ischemic cardiomyapathy, heavy drinker, hearing aid
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: UT981825

Write-up: Pt recv vax on 11/30/98; on 12/1/98 pt exp coldness, fever; on 12/2/98 pt exp hotness; collapsed; pt died


VAERS ID: 117908 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: California  
Vaccinated:1998-10-27
Onset:1998-11-10
   Days after vaccination:14
Submitted: 1998-12-28
   Days after onset:48
Entered: 1999-01-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988202 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood urea increased, Brain oedema, Coma, Diabetes mellitus, Gastroenteritis, Hyperglycaemia, Hyponatraemia, Infection, Ketosis, Vomiting, Weight decreased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (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: 1998-12-12
   Days after onset: 32
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: Beclovent inhaler
Current Illness:
Preexisting Conditions: asthma, rt lower lobe infiltrate, innocent murmur
Allergies:
Diagnostic Lab Data: glucose on admission 1310;NA 124;BUN 31;SGPT 26;CREAT 0.3;SGOT 42;
CDC Split Type:

Write-up: pt recv vax 27OCT98 & 10NOV severe vomiting, glucose 92, felt prob viral age;25NOV seen for OM;29NOV cranky, some vomiting w/nl exam;sl weight loss;3DEC vomited againx2;dx DKA w/glucose 1310;


VAERS ID: 117973 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New York  
Vaccinated:1998-12-07
Onset:1998-12-08
   Days after vaccination:1
Submitted: 1998-12-23
   Days after onset:15
Entered: 1999-01-11
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0944770 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2699AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RIC / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO651 / 1 RL / -

Administered by: Public       Purchased by: Unknown
Symptoms: Asphyxia, Cardiac arrest, Haemorrhage intracranial, Infection, Injury, Pharyngitis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: URI
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv in Emergency Department in cardiac arrest;


VAERS ID: 117974 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:1999-01-06
Onset:1999-01-07
   Days after vaccination:1
Submitted: 1999-01-07
   Days after onset:0
Entered: 1999-01-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454760 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2795A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0026 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0084 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy report COD will be forward upon receipt
CDC Split Type:

Write-up: pt expired w/in 24hr of recv vax;


VAERS ID: 118117 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: West Virginia  
Vaccinated:1998-05-29
Onset:1998-05-30
   Days after vaccination:1
Submitted: 1998-12-31
   Days after onset:215
Entered: 1999-01-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2612A2 / 1 - / L

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Hyperhidrosis, Injection site oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy report indicated COD-SIDS
CDC Split Type:

Write-up: sweating, irritable, crying, swollen inj site, hard to console;pt sent to sleep 2AM & was found 4AM dead;paramedics tried to revive pt;pt was taken to hosp but all attempts to revive pt were fruitless approx 16hr p/vax;


VAERS ID: 118144 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1998-12-29
Onset:1999-01-01
   Days after vaccination:3
Submitted: 1999-01-13
   Days after onset:12
Entered: 1999-01-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455725 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2712A2 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0988220 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N04921 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Rondec DM
Current Illness: mild nasal stuffiness
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative
CDC Split Type:

Write-up: pt was found dead by mom-65hr p/vax;2hr prior to events the mom had fed child w/o problems;


VAERS ID: 118502 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Iowa  
Vaccinated:1998-10-15
Onset:1998-10-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1999-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Condition aggravated, Influenza, Lung disorder, Pneumonia, Pneumonia aspiration, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (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: 1998-11-05
   Days after onset: 12
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:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, IDDM, Smoker, Aspiration pnuemonia, depression, thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: adm w/flu-like sx flu shot 9 days earlier;pt w/underlying COPD went on to devel pneumonia & renal failure & resp failure, died 5NOV;


VAERS ID: 118525 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Florida  
Vaccinated:1998-12-23
Onset:1998-12-23
   Days after vaccination:0
Submitted: 1999-01-21
   Days after onset:29
Entered: 1999-02-03
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0944770 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710192 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0723H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0348 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-27
   Days after onset: 4
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: COD pending autopsy
CDC Split Type: FL98068

Write-up: approx 1hr p/vax pt was a little cranky & had a temp of 101 according to mom, gave APAP, no other problems noted;


VAERS ID: 118536 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1999-01-20
Onset:1999-01-22
   Days after vaccination:2
Submitted: 1999-01-29
   Days after onset:7
Entered: 1999-02-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1400H / 2 - / -

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: 1999-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99011484

Write-up: pt recv vax 20JAN99 & 22JAN99 pt died of SIDS;pt recv first dose 18DEC98;


VAERS ID: 118581 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:1998-11-11
Onset:1998-11-17
   Days after vaccination:6
Submitted: 1999-02-01
   Days after onset:76
Entered: 1999-02-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0919850 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiovascular disorder, Infection, Lung disorder, Pneumonia, Respiratory disorder, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Premarin, Xanax, Myacalcin
Current Illness: NONE
Preexisting Conditions: ulcerative colitis- colectomy, hyst, osteoporosis, thymectomy, breast bx x2
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900068

Write-up: It was reported that a pt expired following vax;


VAERS ID: 118585 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Mississippi  
Vaccinated:1998-12-08
Onset:1998-12-30
   Days after vaccination:22
Submitted: 1999-02-01
   Days after onset:33
Entered: 1999-02-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 094254 / 3 RL / -

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: 1998-12-30
   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: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS99005

Write-up: Pt recv vax on 12/8/98; pt exp SIDS 12/30/98


VAERS ID: 118587 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:1997-03-17
Onset:1997-12-15
   Days after vaccination:273
Submitted: 1999-02-03
   Days after onset:415
Entered: 1999-02-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0359D / 3 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Anorexia, Bone neoplasm, Hepatic neoplasm malignant, Lung neoplasm malignant, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Liver malignant tumours (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-06-16
   Days after onset: 913
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE AT VAX TIME
Current Illness: NONE
Preexisting Conditions: Allergic to Sulfa
Allergies:
Diagnostic Lab Data: Blood work, ultrasound, CT scan, Biopsy of liver
CDC Split Type:

Write-up: Pt recv vax on 3/17/97; on 12/15/97 pt exp decreased appetite, dx=hepatocellular carcinoma; tx=system chemotherapy, chemo-embolizations, liver transplant- 8/98; lung metastases; Annual follow-up dated 10/9/00 states that the pt died on 6/18/00. She experienced spine metastases. She suffered kidney failure. The cancer also returned to her new liver and shedied at the age of 17 1/2.


VAERS ID: 118588 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Carolina  
Vaccinated:1998-12-24
Onset:1999-01-05
   Days after vaccination:12
Submitted: 1999-01-22
   Days after onset:17
Entered: 1999-02-08
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


VAERS ID: 118636 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Unknown  
Vaccinated:1998-10-26
Onset:1998-10-26
   Days after vaccination:0
Submitted: 1999-01-11
   Days after onset:77
Entered: 1999-02-09
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 453671 / 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0433H / 2 RL / UN
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0791C / 1 MO / PO

Administered by: Military       Purchased by: Military
Symptoms: Agitation, Injection site oedema, Injection site pain, Myalgia, Pyrexia, Sudden infant death syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv hep b vax by MDS lot# 1224E given 9SEP98;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt started getting a fever @ 1PM the same day as vax;pt had swelling @ the site of DTP as well as soreness;pt was very cranky & was sore for 3 days following vax;3rd day pt died;


VAERS ID: 118637 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:1998-10-30
Onset:1998-10-30
   Days after vaccination:0
Submitted: 1999-01-04
   Days after onset:66
Entered: 1999-02-09
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 279542 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Cachexia, Dehydration, Gastroenteritis, Infection, Insomnia, Peripheral vascular disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-15
   Days after onset: 16
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 done by medical examiner
CDC Split Type:

Write-up: pt recv vax 30OCT98 at 12:00PM at an office visit;4hr later when pt was fed had a projectile vomiting event in which all the formula was expelled & later pt was cranky & did not sleep @ noc;constant crying & cold hands & feet;


VAERS ID: 118638 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1999-01-04
Onset:1999-01-05
   Days after vaccination:1
Submitted: 1999-01-13
   Days after onset:8
Entered: 1999-02-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0433H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1102H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Interstitial lung disease, Unevaluable event
SMQs:, Interstitial lung disease (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: 1999-01-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 4JAN99 & suffered crib death 5JAN99;


VAERS ID: 118639 (history)  
Form: Version 1.0  
Age: 1.19  
Sex: Male  
Location: California  
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted: 1999-02-01
Entered: 1999-02-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


VAERS ID: 118640 (history)  
Form: Version 1.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1997-12-15
Onset:1998-11-13
   Days after vaccination:333
Submitted: 1999-01-25
   Days after onset:73
Entered: 1999-02-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Cough, Diarrhoea, Drug ineffective, Dyspnoea, HIV infection, Hepatitis, Infection, Pneumonia, Sepsis, Shock, Stomatitis
SMQs:, Hepatitis, non-infectious (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-17
   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:
Current Illness: HIV-hepatitis C & B
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: S pneumoniae type 19F
CDC Split Type:

Write-up: (null)


VAERS ID: 118656 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1998-09-23
Onset:1998-10-04
   Days after vaccination:11
Submitted: 1999-01-26
   Days after onset:114
Entered: 1999-02-09
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455840 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703A9 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361503A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0562 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Hypokinesia, Mental retardation severity unspecified, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac;Reglan;recv hep b #1 at age 2 days;
Current Illness: NONE
Preexisting Conditions: cleft palate, GE reflux, apnea, poor suck & coordination p/ birth, Had some central obstructive apneac episodes beginning at 2-3 wk p/ birth.
Allergies:
Diagnostic Lab Data: EEG x 2 normal, EEG JAN99 abn;MRI brain normal JAN99
CDC Split Type:

Write-up: pt recv vax & began crying & cyanotic spells;admitted for evaluated wk later & felt to be sz episode; Now pt very delayed w/ minimal purposeful movement & continued seizure activity. Annual follow up dated 9/27/00 states that the pt was transferred to another facility. He developed sepsis from S. pneumonia and died a few hours later. 9 months of age at death.


VAERS ID: 118836 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Illinois  
Vaccinated:1999-01-20
Onset:1999-01-22
   Days after vaccination:2
Submitted: 1999-01-28
   Days after onset:6
Entered: 1999-02-10
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0929690 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1363H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Bronchitis, Infection, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-22
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL99005

Write-up: according to the case worker child was seen 4:30 21JAN99-child was happy, playful;no signs of child not feeling well;child was found by foster parents @ 12:45PM in crib not breathing;autopsy was performed-results are pending;


VAERS ID: 119003 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Maryland  
Vaccinated:1999-01-06
Onset:1999-01-15
   Days after vaccination:9
Submitted: 1999-02-11
   Days after onset:27
Entered: 1999-02-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2713A2 / 3 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 7K91768 / 3 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pneumonia @ birth;hospitalized x 1wk/twin birth;
Allergies:
Diagnostic Lab Data: NONE pending autopsy results ?SIDS;
CDC Split Type:

Write-up: none reporter aware of;


VAERS ID: 119004 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Jersey  
Vaccinated:1998-11-20
Onset:1999-01-10
   Days after vaccination:51
Submitted: 1999-01-22
   Days after onset:12
Entered: 1999-02-16
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0918090 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: congenital hydrocephalus, s/p V-P shunt 27OCT98
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: sudden death;unk cause;unable to resuscitate @ ER;


VAERS ID: 119005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Iowa  
Vaccinated:1999-02-04
Onset:1999-02-06
   Days after vaccination:2
Submitted: 1999-02-09
   Days after onset:3
Entered: 1999-02-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 454342 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2713A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP PRN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type: IA99004

Write-up: pt brought to ER w/apparent SIDS;found in crib by caregiver;


VAERS ID: 119053 (history)  
Form: Version 1.0  
Age: 0.14  
Sex: Male  
Location: Rhode Island  
Vaccinated:1999-01-22
Onset:1999-01-23
   Days after vaccination:1
Submitted: 1999-02-09
   Days after onset:17
Entered: 1999-02-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1120H / 2 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-23
   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: No
Preexisting Conditions: Cleft palate
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Died within 24hr of vaccine. Found dead in crib (poss SIDS). Medical examiner report pending.


VAERS ID: 119054 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:1998-08-25
Onset:1998-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 237582 / 2 NA / IM

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Headache, Sudden infant death syndrome, Unevaluable event, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-30
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt seemed very not content, spitting up, acting like had h/a;


VAERS ID: 119055 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1999-02-01
Onset:1999-02-04
   Days after vaccination:3
Submitted: 1999-02-11
   Days after onset:7
Entered: 1999-02-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361503A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0491 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: SIDS event 72hr p/vax;


VAERS ID: 119205 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:1998-09-22
Onset:1998-09-28
   Days after vaccination:6
Submitted: 1999-01-26
   Days after onset:120
Entered: 1999-02-22
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455841 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0939E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 360753A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0212 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI99011

Write-up: mom stated that week before death there was no apparent fever-only some fussiness & lack of appetite, formula intake from 7oz to 3-4oz per feeding;


VAERS ID: 119248 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:1999-02-12
Onset:1999-02-14
   Days after vaccination:2
Submitted: 1999-02-17
   Days after onset:3
Entered: 1999-02-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457788 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1190H / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 110211 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0726 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 1190H / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Drug ineffective, Infection, Sudden infant death syndrome
SMQs:, Lack of efficacy/effect (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pericardial draw post mortem-blood cult grew type B H flu
CDC Split Type:

Write-up: DOA in hosp ER 14FEB99;blood cult grew H. flu type B;


VAERS ID: 119426 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: New York  
Vaccinated:1998-12-04
Onset:1999-02-08
   Days after vaccination:66
Submitted: 1999-02-10
   Days after onset:2
Entered: 1999-02-26
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 456689 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: prempo;Vit E;asa;multivitamin;vit C;fosamax;trazadone;oxybutyrin;calcium carbonate
Current Illness: RLE Cellulitis
Preexisting Conditions: L endarterectomy;s/p abd aortic aneurysm repair;HTN;carotid stenosis;osteoporosis
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 899043051A

Write-up: pt recv vax 4DEC98 & pt was hosp on 8FEB99 dx pneumonia;no cult were performed & causative organism was not identified;pt died on 9FEB99 this is 1 of 5 resident, out of 54 vaccinated, who devel pneumonia p/vax lot# 456689 or 456690;


VAERS ID: 119428 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Male  
Location: New York  
Vaccinated:1998-12-14
Onset:1999-01-26
   Days after vaccination:43
Submitted: 1999-02-10
   Days after onset:15
Entered: 1999-02-26
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 456690 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dehydration, Dementia, Drug ineffective, Infection, Pneumonia
SMQs:, Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-12
   Days after onset: 17
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:
Other Medications: Claforan;Ceftin;Nubain; Morphine;Sorbitol;Pericolace;Vitamin C;Acetaminophen;Tears
Current Illness: unk
Preexisting Conditions: Amoxicillin;Dementia w/ delusions;TIA''s;HTN;;Conjunctivitis;UTI;Parkinson''s Disease;Anemia;DJD;Urinary retention
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 899048005L

Write-up: pt recv vax 14DEC98 & pt devel pneumonia & was hosp;no cult were performed & the causative organism was not identified;pt died on 12FEB99;this is 1 of 5 resident, out of 54 vaccinated who devel pneumonia p/pnu-immune 23 vax;


VAERS ID: 119429 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Female  
Location: New York  
Vaccinated:1999-01-12
Onset:1999-01-25
   Days after vaccination:13
Submitted: 1999-02-10
   Days after onset:16
Entered: 1999-02-26
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 456689 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiovascular disorder, Dehydration, Drug ineffective, Infection, Lung disorder, Pneumonia
SMQs:, Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: kaochlor;digoxin;lasix;cogentin;theragran-m;artificial tears
Current Illness: thick yellow sputum
Preexisting Conditions: Dementia w/ delusions;ASHD;CHF;Schizophrenia
Allergies:
Diagnostic Lab Data: 25JAN99 CXR lt basilar recurrent or chronic infiltrate;6JAN persistent pleural thickening LLL,no new infiltrates
CDC Split Type: 899048006L

Write-up: pt recv vax 12JAN99 & CXR performed 25JAN99 revealed a left basilar recurrent or chronic infiltrate;pt hosp w/dx of pneumonia;no cult were performed & the causative organism was not identified;this is 1 of 5 pt exp pneumonia p/vax;


VAERS ID: 119449 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1998-08-18
Onset:1998-09-15
   Days after vaccination:28
Submitted: 1999-02-25
   Days after onset:163
Entered: 1999-03-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1402H / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bronchitis, Cough, Dyspnoea, Hepatic cirrhosis, Pneumonia, Pulmonary oedema, Right ventricular failure
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 1998-09-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 0 eosinophilia;CXR acute pulmary edema;pt died 16SEP98-no c/o CHF prev;
CDC Split Type:

Write-up: pt recv vax & was adm to hosp on 15SEP98 for inc SOB, cough;cough began right p/vax; ?allergy;no rash, no pharyngeal edema;


VAERS ID: 119691 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted: 1999-02-24
Entered: 1999-03-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


VAERS ID: 119773 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Washington  
Vaccinated:1999-01-20
Onset:1999-01-21
   Days after vaccination:1
Submitted: 1999-03-02
   Days after onset:40
Entered: 1999-03-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1169H / 3 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: reported as SIDS by coroner
CDC Split Type:

Write-up: reported SIDS death about midday following day of vax;no other sickness identified;


VAERS ID: 119774 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Arkansas  
Vaccinated:1999-02-02
Onset:1999-02-18
   Days after vaccination:16
Submitted: 1999-02-26
   Days after onset:8
Entered: 1999-03-08
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2720A2 / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injury, Lung disorder, Unevaluable event
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR9910

Write-up: mom found in crib lifeless;


VAERS ID: 120100 (history)  
Form: Version 1.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:1994-12-01
Submitted: 1999-02-18
   Days after onset:1540
Entered: 1999-03-09
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Confusional state, Dementia, Depressed level of consciousness, Extrapyramidal disorder, Hyperreflexia, Hypertonia, Infection, Laboratory test abnormal, Muscle atrophy, Myasthenic syndrome, Personality disorder
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Malignancy related conditions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-12-12
   Days after onset: 2203
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: EMG reportedly abnormal;unspecified test for stealth virus: reportedly positive;
CDC Split Type: 899050117A

Write-up: pt recv vax as a child & possible re-vax in 1990 & DEC94 devel a flat affect, confusion, brain & motor neuron atrophy & hyperreflexia;pt hosp;several dx have been made including ALS, Parkinson''s, Alzheimer''s & Creutzfeldt-Jakob disease;


VAERS ID: 120158 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: New York  
Vaccinated:1998-12-16
Onset:1998-12-29
   Days after vaccination:13
Submitted: 1999-03-08
   Days after onset:69
Entered: 1999-03-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / 1 GM / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Cough, Dehydration, Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (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), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-05
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atrovent Inhaler 18mcg;Servent Inhalation Aerosol;Depakote Sprinkle Caps;Haldol;Adalat CC;furosemid;Lanoxin;Ducosate sodium
Current Illness: NONE
Preexisting Conditions: Lozol-Dementia, bipolar d/o COPD AF, CHF, HTN
Allergies:
Diagnostic Lab Data: 30DEC98 CXR-possible infiltrate involving RLL
CDC Split Type:

Write-up: 29DEC98 SOB, loose productive cough, elevated T;30DEC98 same, chest x-ray;5JAN99 expired @ hosp;no autopsy;


VAERS ID: 120357 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted: 1999-03-16
Entered: 1999-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455839 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0992660 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy ordered by court
CDC Split Type:

Write-up: found dead in crib in AM on 11FEB99;


VAERS ID: 120411 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Connecticut  
Vaccinated:1998-10-08
Onset:1998-10-19
   Days after vaccination:11
Submitted: 1999-03-10
   Days after onset:142
Entered: 1999-03-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2706A2 / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Crying, Cyanosis, Screaming, Somnolence
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp high pitched tone cry & ate poorly p/1st dose hep b vax;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: autopsy @ chief medical examiners office in Farmington, CT
CDC Split Type:

Write-up: p/2nd vax pt slept more than usual;3 days prior to death slept almost cont on day died, only took 1 bottle all day;830PM woke up from sleep screaming, had sz, turned blue died in amb approx 15min later;


VAERS ID: 120449 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-03-16
Entered: 1999-03-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: combined immunity deficiency
Allergies:
Diagnostic Lab Data: viral RN template nucleotide sequencing showed that both the fusion (F) & hemagglutinin (MA) gene sequences were identical to the comparable regions of the vaccine strain, moratan;
CDC Split Type: WAES99030358

Write-up: per lit ref pt recv vax 6wk a/hosp adm;postmortem histological exam of lung showed a severe, diffuse, intra-alveolar giant cell pneumonia;typical multinucleated giant cells of the warthin-Finkeldey type w/prominent inclusions seen;


VAERS ID: 120450 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Alabama  
Vaccinated:1999-03-10
Onset:1999-03-13
   Days after vaccination:3
Submitted: 1999-03-18
   Days after onset:5
Entered: 1999-03-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 865A2 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0734E / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 79413 / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 10524 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Hepatomegaly, Laboratory test abnormal, Lymphadenopathy, Myocarditis, Neoplasm, Pneumonia, Pyrexia, Splenomegaly, Vaginal haemorrhage, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: lt lung culture:Viridans Streptococcus, 2 colonies Candida, Haemophilus, beta lactamase+; rt lung culture: haemophilus, beta lactamase+; Blood culture: Staphylococcus epidermidis
CDC Split Type: AL9904

Write-up: hx of pt arriving in ER in full arrest & expired @ hosp;sl bloody vaginal discharge noted in ER;


VAERS ID: 120511 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-03-03
Entered: 1999-03-23
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Immune system disorder, Infection, Paralysis flaccid
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: pt sibling also had a severe immune deficiency & devel vax assoc paralytic polio~ ()~~~In Sibling
Other Medications: unk
Current Illness: unk
Preexisting Conditions: severe immune deficiency
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 899072060A

Write-up: MD reported pt recv vax & devel vaccine-associated paralytic poliomyelitis;it was later determined that pt had severe immune deficiency;the child died 8 or 9 years ago d/t the immunodeficiency;MD stated event poss reported to CDC;


VAERS ID: 120512 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-03-03
Entered: 1999-03-23
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Immune system disorder, Infection, Paralysis flaccid
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: pt sibling had severe immune deficienty & devel vax assoc paralytic polio~ ()~~~In Sibling
Other Medications: unk
Current Illness: unk
Preexisting Conditions: severe immune deficiency
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 899077002L

Write-up: pt recv vax & devel vaccine-associated paralytic poliomyelitis;it was later determined that the pt had severe immun deficiency;the child died 4 or 5 year ago d/t the immunodeficiency;MD stated this event may have been reported to CDC;


VAERS ID: 120597 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: California  
Vaccinated:1999-02-18
Onset:1999-02-21
   Days after vaccination:3
Submitted: 1999-03-19
   Days after onset:26
Entered: 1999-03-29
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 858A2 / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0003H / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 2 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Cardiac arrest, Pyrexia, Sudden infant death syndrome, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed-results unavailable @ this time;
CDC Split Type:

Write-up: pt found by parent not breathing, CPR started, transported to nearest ER on 21FEB99, unable to resuscitate;


VAERS ID: 120891 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Texas  
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted: 1999-03-31
Entered: 1999-04-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (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), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-19
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: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC Split Type:

Write-up: (null)


VAERS ID: 121004 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-03-31
Entered: 1999-04-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV: JAPANESE ENCEPHALITIS (J-VAX) / CONNAUGHT LABORATORIES - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Hyperthermia malignant, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pseudoephedrine
Current Illness:
Preexisting Conditions: mild obesity, 1 episode of heat exhaustion preceding summer
Allergies:
Diagnostic Lab Data: autopsy moderately enlarged heart w/early moderate atherosclerotic cardiovascular disease, but no evidence of heart failure or thrombosis;
CDC Split Type: U199900204

Write-up: lit ref- pt taking OTC pseudoephedrine for wt loss died suddenly during exercise shortly p/vax;pt collapsed in mild weather while exercising 75min p/vax; presented in asystole w/ core temp 42.2C(108F), no urticaria or angioedema;


VAERS ID: 121006 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1999-03-20
Onset:1999-03-28
   Days after vaccination:8
Submitted: 1999-04-06
   Days after onset:8
Entered: 1999-04-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456819 / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0998900 / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Tobrex eye drops
Current Illness: conjunctivitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died 28MAR99;pt recv vax30AR99;no other adverse reactions were reported;found in crib apneic & pulseless;taken to hosp & tried to be resuscitated but unsuccessful;


VAERS ID: 121007 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Michigan  
Vaccinated:1999-03-30
Onset:1999-04-01
   Days after vaccination:2
Submitted: 1999-04-06
   Days after onset:4
Entered: 1999-04-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 888A2 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1394H / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0998890 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NA
Current Illness: diaper rash
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt was given last feeding @ 4AM, smiling & doing well;found in crib @ 7AM unresponsive;CPR started & taken to hosp, unsuccessful in resuscitation;mom states pt cranky 31MAR when someone touched where immun given;


VAERS ID: 121059 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maryland  
Vaccinated:1999-03-26
Onset:1999-04-02
   Days after vaccination:7
Submitted: 1999-04-02
   Days after onset:0
Entered: 1999-04-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS death 7 days p/vax;


VAERS ID: 121163 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1999-04-02
Onset:1999-04-03
   Days after vaccination:1
Submitted: 1999-04-12
   Days after onset:8
Entered: 1999-04-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 120B9 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lopressor HCT
Current Illness:
Preexisting Conditions: allergy to PCN;HTN;DJD;cervical arthritis;cervical radiculopathycarpal tunnel synd;hx urolithiasis
Allergies:
Diagnostic Lab Data: 1OCT1998 cardiology consult-nl;16OCT1998 Thallium stress test-nl;2APR1999 physical exam-BP 152/92,P 60,R 16,T 96 degrees
CDC Split Type: 19990081531

Write-up: pt recv vax 2APR99 & 1 day later on 3APR99 pt dropped dead in yard;It was not specified if emergency treatment was administered;COD reported as sudden death;It was not specified if an autopsy was performed nor was the certified COD provided


VAERS ID: 121253 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1998-11-18
Onset:1998-11-19
   Days after vaccination:1
Submitted: 1999-04-12
   Days after onset:143
Entered: 1999-04-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cerebral haemorrhage, Cerebral infarction, Cerebrovascular disorder, Convulsion, Encephalitis, Immune system disorder, Lymphocytosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: 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? No
Previous Vaccinations:
Other Medications: pt recv hep b vax 19SEP98 & 19OCT98
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Brain MRI/CT w/rapidly progressive infarcts, atrophy & hemorrhage;autopsy showed meningoenchephalitis w/hemophagocytosis suggesting an inflammatory process to unk antigen or familial hemophagocytic lymphohistiocytosis
CDC Split Type:

Write-up: pt adm to hosp 19NOV98 w/new onset sz;dx rapidly progressive necrotizing encephalitis;clinically thought to be most consistent w/mitochondrial cytopathy although studies pending;autopsy showed meningoenchephalitis w/hemophagocytosis


VAERS ID: 121372 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-08-18
Onset:1993-08-20
   Days after vaccination:2
Submitted: 1999-04-06
   Days after onset:2055
Entered: 1999-04-21
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1055A4 / 5 - / -

Administered by: Private       Purchased by: Other
Symptoms: Antinuclear antibody, Asthenia, Blindness, CSF test abnormal, Constipation, Cough, Hiccups, Hyporeflexia, Immune system disorder, Infection, Influenza, Laboratory test abnormal, Lymphoedema, Malaise, Myalgia, Myasthenic syndrome, Myelitis, Neuropathy, Optic neuritis, Paraesthesia, Paralysis, Pruritus, Pseudo lymphoma, Pyrexia, Urinary retention, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular infections (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-02-28
   Days after onset: 1653
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: pt-mild fatigue, body aches and flu-like sx-HEP #4 (7/93)~ ()~~~In patient
Other Medications: Advil w/ initial flu sx-got rash & hiccups p/ taking
Current Illness: sinus problems
Preexisting Conditions: chronic sinus drainage, NKDA
Allergies:
Diagnostic Lab Data: MRI-cervical/ thoracic spine- abn C4-C5 & T6-T8; MRI brain-abn lt optic nerve;ANA+;gamma globulins 1.41;CSF: protein 192,EBV IgG 1:512, IgM 1:10
CDC Split Type:

Write-up: p/vax pt had fatigue, body aching, flu-like sx;3/94 neuro MD eval sx:lt eye blindness, numbness (arms/legs) /weakness/paralysis legs, unable to urinate, constipation, tingling & numbness-trunk,dx: transverse myelitis, optic neuritis, MS


VAERS ID: 121425 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Georgia  
Vaccinated:1999-03-11
Onset:1999-04-02
   Days after vaccination:22
Submitted: 1999-04-09
   Days after onset:6
Entered: 1999-04-23
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA99033

Write-up: None reported to this facility;


VAERS ID: 121584 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:1999-03-19
Onset:1999-03-21
   Days after vaccination:2
Submitted: 1999-04-22
   Days after onset:31
Entered: 1999-04-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: mild URI afeb-exam negative;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: reporter does not have copy of autopsy report;
CDC Split Type:

Write-up: none at time of administration;apparent SIDS death 21MAR99;


VAERS ID: 121689 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:1999-02-08
Onset:0000-00-00
Submitted: 1999-02-26
Entered: 1999-04-29
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 0970140 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2602A9 / UNK RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0996880 / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NV99006

Write-up: apnea


VAERS ID: 121993 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: California  
Vaccinated:1999-04-19
Onset:1999-04-20
   Days after vaccination:1
Submitted: 1999-05-06
   Days after onset:16
Entered: 1999-05-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A888A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 799F4 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: mild broncholitis/congestion x3 in past wks
Preexisting Conditions: recurrent c/o congestion & bronchitis, impetigo
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt died;SIDS or pneumonia;


VAERS ID: 122131 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Female  
Location: Alaska  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-05-11
Entered: 1999-05-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Bradycardia, Chest pain, Cough, Dehydration, Drug ineffective, Dyspnoea, Hypoventilation, Hypoxia, Laboratory test abnormal, Lung disorder, Pneumonia, Pneumothorax, Productive cough, Pyrexia, Respiratory disorder, Sepsis, Tachycardia, Thinking abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: alcoholism
Allergies:
Diagnostic Lab Data: x-ray chest RLL consolidation compatible w/adult RSD;WBC 800 w/40% band forms;blood culture yielded S. pneumoniae
CDC Split Type: WAES99050349

Write-up: pt to hosp for eval of 4day hx of fever, productive cough & rt pleuritic chest pain;T101, tachycardia, dec breath sounds;tx IV & O2;mental status dec;resp distress;ARDS;pneumonia;ventilator;recurrent pneumothorax;bradycardia;COD septicemia;


VAERS ID: 122135 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1999-04-21
Onset:1999-04-22
   Days after vaccination:1
Submitted: 1999-05-03
   Days after onset:11
Entered: 1999-05-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457788 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 410303A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0400 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988075 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: prematurity
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: sudden infant death w/in 24hr;autopsy was nl;


VAERS ID: 122214 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1997-07-30
Onset:1997-08-27
   Days after vaccination:28
Submitted: 1999-05-12
   Days after onset:623
Entered: 1999-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6671162 / 1 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 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: 1997-08-27
   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: pt recv hep b vax 30MAY97;
Current Illness: NONE
Preexisting Conditions: at 1month hosp w/gastroenteritis (25JUN97 discharged),Dx colitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9737

Write-up: SIDS;2wk physical exam normal;15JUN97 hosp;16JUN97 discharged form hosp w/colitis, bloody diarrhea probably d/t milk allergy, changed formula to soy;


VAERS ID: 122215 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1998-12-16
Onset:1998-12-21
   Days after vaccination:5
Submitted: 1999-05-12
   Days after onset:141
Entered: 1999-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 862H2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / UNK LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0950670 / UNK RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / UNK 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: 1998-12-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Mylanta for GER
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9821

Write-up: SIDS


VAERS ID: 122252 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Texas  
Vaccinated:1998-12-02
Onset:1998-12-03
   Days after vaccination:1
Submitted: 1999-01-22
   Days after onset:50
Entered: 1999-05-20
   Days after submission:117
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0929690 / 3 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0944740 / 3 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 452111 / 3 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Adrenal disorder, Apnoea, Cardiac arrest, Coma, Cough, Cyanosis, Dementia, Mydriasis, Neonatal disorder, Peripheral vascular disorder, Pupillary disorder, Stupor, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-03
   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: Amoxil
Current Illness: rt OM & croup
Preexisting Conditions: NKDA;
Allergies:
Diagnostic Lab Data: Glascow coma scale score 33;no bloodwork
CDC Split Type:

Write-up: pt coughing 2DEC98 during noc; pt found unresponsive in bed 0500 3DEC98;CPR initiated @home; pupils fixed & dilated, no spontaneous breathing, cool cyanotic skin; unresponsive, apneic, asystolic,cardiopulmonary arrest;


VAERS ID: 122254 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1999-04-20
Onset:1999-04-21
   Days after vaccination:1
Submitted: 1999-04-27
   Days after onset:6
Entered: 1999-05-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 865A2 / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1613H / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Heart disease congenital
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL99018

Write-up: none reported other than pt found dead in crib @ 8AM;


VAERS ID: 122391 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Florida  
Vaccinated:1999-05-18
Onset:1999-05-18
   Days after vaccination:0
Submitted: 1999-05-20
   Days after onset:2
Entered: 1999-05-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457793 / 1 RA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1091H / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P00842 / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Congenital anomaly, Dysphagia, Dyspnoea, Somnolence, Vascular anomaly, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-05-18
   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: Zantac, Digoxin, Lasix, Captopril, PCN
Current Illness: NA
Preexisting Conditions: s/p Blalock-Taussig shunt-single ventricle, transposition of Great Vessels, situs inversus; Asplenia
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt reported to have choking episode & resp distress & lethargy;led to resp arrest then cardiac arrest;


VAERS ID: 122395 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Montana  
Vaccinated:1999-01-06
Onset:1999-02-04
   Days after vaccination:29
Submitted: 1999-04-27
   Days after onset:81
Entered: 1999-05-24
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455726 / 4 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1102H / 4 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Atelectasis, Bradycardia, Cardiac arrest, Dyspnoea, Hypoxia, Laboratory test abnormal, Leukocytosis, Pneumonia, Pyrexia, Respiratory disorder, Tachycardia
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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-04
   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: Pediazole;Dimetapp; Motrin
Current Illness: OM
Preexisting Conditions: allergy to amoxicillin
Allergies:
Diagnostic Lab Data: sputum cult strep pneumoniae;CXR atelectasis lt lower lung & rt mid lung; WBC-22.3,RBC-4.50, hgb-11.4, HCT-35.1, 02 sat 79-84%;heart rate 160-180;ABG: pO2-126, pCO2-64
CDC Split Type: MT99005

Write-up: child adm to ER 4FEB99 less than 30 days p/vax;pt presented to ER in resp distress, T101, retractions;intubated;had bradycardia then loss of pulse, expired 1105pm 4Feb99, cause of death: pneumonia


VAERS ID: 122669 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Unknown  
Vaccinated:1999-04-26
Onset:1999-04-28
   Days after vaccination:2
Submitted: 1999-05-20
   Days after onset:22
Entered: 1999-05-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Apnoea, Cardiac arrest, Ecchymosis, Pyrexia, Rash, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), 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: 1999-05-02
   Days after onset: 4
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: lt hip dysplasia;otic infection;seizure
Allergies:
Diagnostic Lab Data: bacterial cult (blood/spleen/brain/lungs)=neg;xrays=nl; child had small bruise on head from fall-no evidence of trauma; viral cult (brain/lung/intestine) not avail
CDC Split Type: WAES99050142

Write-up: mo put sunscreen on face day of vax;2 days p/ vax little red dots on upper cheeks, not itchy & T99.3-99.5(ear);4th and 5th day p/ vax, afebrile but out of sorts & wanting to be held more; AM-6th day found dead in bed, COD SIDS, autopsy neg.


VAERS ID: 122670 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New York  
Vaccinated:1998-09-15
Onset:1998-09-15
   Days after vaccination:0
Submitted: 1999-05-20
   Days after onset:247
Entered: 1999-05-25
   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: Convulsion, Dyspnoea, Gastrointestinal disorder, Somnolence
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-09-15
   Days after onset: 0
Permanent Disability? Yes
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: WAES99050904

Write-up: pt recv vax & 16hr post vax pt died; pt seemed fine immed p/vax but few hours later devel sudden difficulty in breathing which resembled convuls; pt didn''t breath properly & appeared to be convuls & would not burp;then went to sleep fast


VAERS ID: 122712 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:1999-04-30
Onset:1999-05-02
   Days after vaccination:2
Submitted: 1999-05-10
   Days after onset:8
Entered: 1999-05-26
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 099V190 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1232H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12941 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-05-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: 18MAR99 gentamycin opth drops;2 drops q 6hr for 5 days;
Current Illness: NONE
Preexisting Conditions: congenital dacryostenosi left;dacryocystitis left
Allergies:
Diagnostic Lab Data: 18MAR99 bacterial cult lt eye results scant growth;streptococcus viridans & staphylococcus epidermidis
CDC Split Type: CA990044

Write-up: SIDS death;pt found by mom 2MAY99 @ 716AM face down, in playpen not breathing;paramedics called by father;pt had been fed 1MAY99 11PM by mom & put down in playpen on back @ midnight 2MAY99; no signs of trauma or foul play


VAERS ID: 122713 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1999-03-03
Onset:1999-03-21
   Days after vaccination:18
Submitted: 1999-05-17
   Days after onset:56
Entered: 1999-05-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2930A292501 / 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: 1999-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: mom was a smoker
Allergies:
Diagnostic Lab Data: 16MAR99 seen by MD for wellchild everything WNL
CDC Split Type: NH9904

Write-up: SIDS


VAERS ID: 123167 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New Hampshire  
Vaccinated:1998-04-15
Onset:1998-04-25
   Days after vaccination:10
Submitted: 1999-05-21
   Days after onset:391
Entered: 1999-05-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0078H / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 2 LL / SC

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

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: none~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: umbilical hernia-resolving;
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9814

Write-up: SIDS


VAERS ID: 123168 (history)  
Form: Version 1.0  
Age: 0.08  
Sex: Male  
Location: New Hampshire  
Vaccinated:1999-03-24
Onset:1999-04-24
   Days after vaccination:31
Submitted: 1999-05-20
   Days after onset:26
Entered: 1999-05-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2930A2 / 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: 1999-04-24
   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: NONE
Current Illness: NONE
Preexisting Conditions: rt hip click
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9905

Write-up: SIDS. Autopsy report confirms SIDS with pleural petechiae.


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