National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Found 8,467 cases where Patient Died

Case Details

This is page 16 out of 85

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


VAERS ID: 123185 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: New York  
Vaccinated:1995-02-10
Onset:1995-02-20
   Days after vaccination:10
Submitted: 1999-05-26
   Days after onset:1555
Entered: 1999-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Aplastic anaemia, Encephalitis, Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (narrow), Hypersensitivity (narrow), Myelodysplastic syndrome (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: 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: roseola type virus,fever,rash p/ MMR #1~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: fever;viral exanthema;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99051409

Write-up: pt recv vax & became ill 10 days p/vax;pt had a viral synd which devel into encephalitis & was hosp;pt then devel aplastic anemia & dx w/Dubowitz synd;pt had recurrence of aplastic anemia;pt died


VAERS ID: 123218 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Oregon  
Vaccinated:1999-04-10
Onset:1999-04-30
   Days after vaccination:20
Submitted: 1999-05-21
   Days after onset:21
Entered: 1999-06-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC Split Type:

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


VAERS ID: 123703 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1999-05-28
Onset:1999-06-07
   Days after vaccination:10
Submitted: 1999-06-07
   Days after onset:0
Entered: 1999-06-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2544A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & arrived @ hosp DOA medical exam report pending;


VAERS ID: 124694 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:1998-11-01
Onset:1999-02-20
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 1999-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0973930 / UNK - / -

Administered by: Other       Purchased by: Public
Symptoms: Drug ineffective, Hypoxia, Infection, Lung disorder, Pneumonia, Pyrexia, Respiratory disorder, Shock
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Lack of efficacy/effect (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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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: 1999-03-21
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD influenza complicated by pneumococcal pneumonia;2/23/99 WBC 6.4, 19% bands;2/24/99 WBC 7.3, 18% bands;CXR showed hazy lt lower lung base;3/17/99 tracheostomy performed;
CDC Split Type: TX99112

Write-up: fever & mild upper airway sx, then lower resp problems w/dec 02;dx influenza, r/o pneumonia;deteriorated;required intubation, ventilation support;dx pneumococcal pneumonia;devel shock, father req no aggressive tx-pt died; father ref autopsy


VAERS ID: 124771 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: New Mexico  
Vaccinated:1999-06-04
Onset:1999-06-05
   Days after vaccination:1
Submitted: 1999-06-08
   Days after onset:3
Entered: 1999-06-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462315 / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Asphyxia, Cardiac arrest, Injury, Petechiae, Stupor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-05
   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: 12/28/98 SKB DTaP888A2;4/2/99 SKB DTaP890A2;
Current Illness: viral
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found unresponsive;could not be resuscitated;is open medical examiners case;


VAERS ID: 124936 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:1999-05-24
Onset:1999-06-01
   Days after vaccination:8
Submitted: 1999-06-15
   Days after onset:14
Entered: 1999-06-17
   Days after submission:2
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 0798D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Coagulopathy, Febrile convulsion, Gastroenteritis, Gastrointestinal haemorrhage, Grand mal convulsion, Lung disorder, Pulmonary oedema, Vaginal haemorrhage, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-06-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: twin recv OPV same day & devel diarrhea (see #125065)~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 6/1/99 blood culture neg, CSF neg, metabolic screen for toxic substance neg, mean platelet vol 6.9 low,
CDC Split Type: WAES99060681

Write-up: pt recv vax 5/24/99 & 6/1/99 pt was found to have a fever & p/waking up from nap, had sz & was rushed to ER where was unable to be resuscitated;COD @ time of reporting was unk;


VAERS ID: 124943 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Arkansas  
Vaccinated:1999-06-01
Onset:1999-06-02
   Days after vaccination:1
Submitted: 1999-06-09
   Days after onset:7
Entered: 1999-06-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2933A2 / 2 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Sudden infant death syndrome, Unevaluable event
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-02
   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: pt recv hep vax 4/11/99
Current Illness: NONE
Preexisting Conditions: no related on 6/3/99;seeing MD for shrinking heart;
Allergies:
Diagnostic Lab Data: 6/4/99 autopsy sids;
CDC Split Type: AR 99-21

Write-up: died @ home; autopsy SIDS


VAERS ID: 124944 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Arkansas  
Vaccinated:1999-06-04
Onset:1999-06-09
   Days after vaccination:5
Submitted: 1999-06-14
   Days after onset:5
Entered: 1999-06-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0998410 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1237H / 1 GM / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0596 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Asphyxia, Cardiac arrest, 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), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nystatin oral syrup
Current Illness: nasal congestion & oral thrush
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy done-report not yet in
CDC Split Type: AR9925

Write-up: pt seen 6/4/99 had nl exam & no problems exist reported nasal congestion for over a month;also had oral thrush;congestion was felt to be ?secondary to milk allergy & recommended change to soy;given med for thrush;found dead in bed w/parent


VAERS ID: 125076 (history)  
Form: Version 1.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:1999-06-10
Onset:1999-06-13
   Days after vaccination:3
Submitted: 1999-06-16
   Days after onset:3
Entered: 1999-06-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Arteriosclerosis, Cardiovascular disorder, Condition aggravated, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: An autopsy was performed & the COD was determined to be cardiovascular disease & HTN;
CDC Split Type: 19990139611

Write-up: pt who was reported in excellent health & did not have HTN, high cholesterol, or cardiovascular disease recv vax & was found dead;COD=cardiovascular disease & HTN


VAERS ID: 125168 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Connecticut  
Vaccinated:1999-05-21
Onset:1999-05-27
   Days after vaccination:6
Submitted: 1999-06-22
   Days after onset:26
Entered: 1999-06-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0311J / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dehydration, Hepatic function abnormal, Hyponatraemia, Infection, Leukopenia, Meningitis, Pancytopenia, Rash, Thinking abnormal, Thrombocytopenia, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-05-29
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: no known prexisting problems
Allergies:
Diagnostic Lab Data: leukepenia platlets, elevated lft''s 5/27/99
CDC Split Type:

Write-up: pt well when vax given, presented w/rom 5/2699 & vomiting. transferred to hosp where she died of pneumoccocal meningitis


VAERS ID: 125479 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1999-06-09
Onset:0000-00-00
Submitted: 1999-06-14
Entered: 1999-07-12
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2794A2 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1101H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N05972 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Infection, Lymphadenopathy, Pharyngitis, Pneumonia, Pulmonary oedema, Rash, Unevaluable event
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-11
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 performed-no results available yet
CDC Split Type: GA99063

Write-up: p/vax mom given education red: vaccines; they advised around the clock APAP for the first 1-2 d p/vax; pt died


VAERS ID: 126150 (history)  
Form: Version 1.0  
Age: 0.16  
Sex: Male  
Location: Utah  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-13
   Days after onset:3
Entered: 1999-07-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / UNK RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0964270 / UNK RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / UNK LL / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, 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), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications: tylenol
Current Illness: nasal stuffiness -+ np swab moraxella catarrbalis
Preexisting Conditions: nicu x 5d presummed congenital sepsis
Allergies:
Diagnostic Lab Data: not known care provided by ER
CDC Split Type:

Write-up: p/vax pt fed & then found unresponsive; asystolic on arrival to hosp; unable to resuscitate; all sutures split in cranium


VAERS ID: 126217 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1999-06-08
Onset:1999-06-15
   Days after vaccination:7
Submitted: 1999-06-16
   Days after onset:1
Entered: 1999-07-21
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1814H / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 1618H / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-15
   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:
Current Illness: 1-2 days of inc emesis, week prior, had resolved
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: unsure
CDC Split Type:

Write-up: pt died yesterday, 6 days p/ 2mo well child check-up, where 2mo vax given. unsure of details of death. autopsy results pending.


VAERS ID: 126221 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Minnesota  
Vaccinated:1999-02-18
Onset:1999-02-23
   Days after vaccination:5
Submitted: 1999-07-16
   Days after onset:142
Entered: 1999-07-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 458588 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1616H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. W08252 / 1 LA / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988055 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Gastroenteritis, Gastrointestinal haemorrhage, Gastrointestinal necrosis, Infection, Pharyngitis, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal haemorrhage (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Ischaemic colitis (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-24
   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: lotrisone cream
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy showed 8cm intussusception w/hyperemic necrosis & septic shock; also pos for RSV
CDC Split Type:

Write-up: 5 days p/vax pt treated in ER for gastroenteritis & pharyngitis. given phenergan & amoxicillin. 2/24/99 devel rectal bleeding; expired while awaiting transport to pediatric ICU


VAERS ID: 126277 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Mississippi  
Vaccinated:1999-07-15
Onset:1999-07-16
   Days after vaccination:1
Submitted: 1999-07-20
   Days after onset:4
Entered: 1999-07-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462315 / 2 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0575H / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0938 / 2 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Anaphylactoid reaction, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-07-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none known
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type: MS99025

Write-up: pt was given APAP at midnight, day of vax & pt was alert & awake, but felt warm; pt found 6am-615am on 7/16 & time of death was estimated to be 2hrs. earlier


VAERS ID: 126435 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1999-07-28
Onset:1999-07-28
   Days after vaccination:0
Submitted: 1999-07-29
   Days after onset:1
Entered: 1999-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A911A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1771H / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N09522 / 2 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature, apnea-no longer on monitor
Allergies:
Diagnostic Lab Data: was coded and pronounced dead @ hosp
CDC Split Type:

Write-up: parents found child dead in crib;


VAERS ID: 126759 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1998-11-07
Onset:1998-11-18
   Days after vaccination:11
Submitted: 1999-07-26
   Days after onset:249
Entered: 1999-08-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 1 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: 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: NH9825

Write-up: SIDS - 11/25/1998. MD reported pt had a displaced skull fracture


VAERS ID: 126855 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-07-29
Entered: 1999-08-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99071550

Write-up: rpt from anonymous person concerning pt who was vax & exp slight fever, tx w/tylenol; pt found dead next morning; COD unk; the rpt stated info was recv as "hearsay'''' through small town grapevine & cannot be verified.


VAERS ID: 127043 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1998-10-07
Onset:1998-12-21
   Days after vaccination:75
Submitted: 1999-08-02
   Days after onset:223
Entered: 1999-08-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration
SMQs:, Gastrointestinal obstruction (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: ~ ()~~~In patient
Other Medications: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death; autopsy performed by county; aspiration pneumonia;


VAERS ID: 127057 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1999-03-11
Onset:1999-03-20
   Days after vaccination:9
Submitted: 1999-07-23
   Days after onset:124
Entered: 1999-08-10
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-21
   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: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC Split Type: 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


VAERS ID: 127061 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Ohio  
Vaccinated:1999-07-12
Onset:1999-07-15
   Days after vaccination:3
Submitted: 1999-08-02
   Days after onset:18
Entered: 1999-08-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 46235J / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P02572 / 2 RL / SC

Administered by: Private       Purchased by: Other
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: 1999-07-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt hosp x 2 days on 4/2/99 for pneumonia;
Allergies:
Diagnostic Lab Data: chest, abd, skull, extremities x-rays nl;
CDC Split Type:

Write-up: child found by dad when he came home from work, was in cardiopulmonary arrest;ambulance called;EMS intubated child;on route to ER given atropine;there was no peripheral IV access; needle placed in rt anterior tibia


VAERS ID: 127062 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1999-07-07
Onset:1999-07-15
   Days after vaccination:8
Submitted: 1999-08-05
   Days after onset:21
Entered: 1999-08-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462355 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2909A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0258 / 1 RL / SC

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: 1999-07-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: h/o innocent heart murmur-echo WNL
Allergies:
Diagnostic Lab Data: post mortem exam dx SIDS
CDC Split Type:

Write-up: child was placed prone to sleep in early morning hours of 7/15/99;child found dead a few hours later;


VAERS ID: 127076 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Male  
Location: Ohio  
Vaccinated:1999-06-15
Onset:1999-07-08
   Days after vaccination:23
Submitted: 1999-07-12
   Days after onset:4
Entered: 1999-08-10
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 902A2 / 3 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2942A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 412353A / 3 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Acidosis, Agitation, Apnoea, Cardiac arrest, Congenital anomaly, Convulsion, Crying, Encephalopathy, Gastrointestinal disorder, Gastrointestinal necrosis, Hypovolaemia, Intestinal gangrene, Intestinal obstruction, Sepsis, Shock, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-07-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: 3/11/99 PA tubes in ears
Allergies:
Diagnostic Lab Data: 3/28/99 similar episode-Barium enema showed malrotation (intussusception) & pt transferred;ped surgeon stated interpretation was wrong & x-ray was nl & sent home;x-rays, labs studies, surgery;
CDC Split Type: OH99048

Write-up: 7/8/99 225PM began vomiting & shrill cry;phoned MD & child taken to ER;pt went into shock,transferred to ped ICU;coded 15min later 11:30PM;taken to surgery,all intestines were black;had malrotation (intussusception);7/9/99 sz;


VAERS ID: 127131 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-07-26
Entered: 1999-08-12
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Ascites, Blood fibrinogen decreased, Coagulation time prolonged, Haemochromatosis, Hepatic failure, Hepatic function abnormal, Hepatosplenomegaly, Hypotension, Jaundice, Laboratory test abnormal, Pneumonia, Pyrexia, Sepsis, Thrombocytopenia
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), 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: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: a retrospective review of autopsy material from a sister & cousin of this pt suggested that 3 members of fam died from hemophagocytic lympohistiocytosis
Allergies:
Diagnostic Lab Data: fibrinogen 50;ferritin 32;AST 3938;ALT 1041;T Bili 6.4;PT 22.6;APTT $g;plts 20; WBC 4500;lymphs 30%;atypical lymphs 67%; CT-infiltrated appearance of liver & acites;bone marrow-granulopoiesis,dyserythro; & lympohist;
CDC Split Type: 899211015A

Write-up: lit ref:p/recv vax pt devel fever 104F, jaundice, hepatosplenomegaly, elevated liver function; Dx=neonatal hemochromatosis; awaiting liver transplant; devel Klebsiella pneumonia, septicemia & hypotens; Dx= hemophagocytic lymphohistiocytosis


VAERS ID: 127161 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1999-07-12
Onset:1999-07-14
   Days after vaccination:2
Submitted: 1999-08-05
   Days after onset:22
Entered: 1999-08-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Gastrointestinal malformation, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock
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), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-07-15
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC Split Type:

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


VAERS ID: 127166 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Kentucky  
Vaccinated:1998-07-15
Onset:1998-07-27
   Days after vaccination:12
Submitted: 1999-02-12
   Days after onset:200
Entered: 1999-08-13
   Days after submission:181
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 449070 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079H / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0214 / 2 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: 1998-07-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: n/a
Current Illness: N/A
Preexisting Conditions: nka
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type: KY990011

Write-up: 7/28/98 learned via media that infant was the victim of SIDS


VAERS ID: 127167 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Kentucky  
Vaccinated:1999-03-17
Onset:1999-04-09
   Days after vaccination:23
Submitted: 1999-04-19
   Days after onset:10
Entered: 1999-08-13
   Days after submission:116
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1590H / 1 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Unevaluable event
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: milk & soy allergies; on nuetramagen; weight 2lbs @ 2wk old
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY990018

Write-up: none


VAERS ID: 127169 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Kentucky  
Vaccinated:1998-12-18
Onset:0000-00-00
Submitted: 1999-04-27
Entered: 1999-08-13
   Days after submission:108
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0575H / 3 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 457843 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-22
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 rpt
Current Illness: none
Preexisting Conditions: surgery 12/97 for double hernia & pyloric stenosis?
Allergies:
Diagnostic Lab Data: death certificate also showed battered child synd;
CDC Split Type: KY990021

Write-up: pt death occurred at home; autopsy findings were available prior to completion of cause of death: a. findings consistent w/asphyxia/ suffocation;


VAERS ID: 127170 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Kentucky  
Vaccinated:1999-05-27
Onset:1999-06-26
   Days after vaccination:30
Submitted: 1999-07-06
   Days after onset:10
Entered: 1999-08-13
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0136J / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Cystitis, Pyelonephritis, Sepsis, Urinary tract disorder
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), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: KY990025

Write-up: pt death at 1 month of age


VAERS ID: 127341 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1999-07-08
Onset:1999-07-10
   Days after vaccination:2
Submitted: 1999-07-12
   Days after onset:2
Entered: 1999-08-19
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0257J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0257 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hep, 4/27/99
Current Illness: none
Preexisting Conditions: 35 week premature; 2 vessel cord; jaundice; sacral dimple; single kidney; low sono; hernia
Allergies:
Diagnostic Lab Data: at County Coroner
CDC Split Type:

Write-up: pt presented DOA; possible SIDS; possible maternal overlay;


VAERS ID: 127431 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New York  
Vaccinated:1999-07-20
Onset:1999-07-25
   Days after vaccination:5
Submitted: 1999-08-17
   Days after onset:23
Entered: 1999-08-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2941A2 / 2 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N1180AA / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0040 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: 6/3/99-hepB #1, merck, #321030
Current Illness: none
Preexisting Conditions: small unmbilical hernia (<0.5cm)
Allergies:
Diagnostic Lab Data: newborn screening within acceptable limits
CDC Split Type:

Write-up: 5 days s/p vax pt was sleeping w/mom; pt presented to the ED in asystole; pt had been sleeping w/mom on couch; pt had blood from both nares in field; possible SIDS (pt expired); investigation ongoing;


VAERS ID: 127554 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Idaho  
Vaccinated:1999-07-29
Onset:1999-08-05
   Days after vaccination:7
Submitted: 1999-08-11
   Days after onset:6
Entered: 1999-08-24
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462317 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0701AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N06991 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 127780 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Male  
Location: Maryland  
Vaccinated:1999-07-19
Onset:1999-07-23
   Days after vaccination:4
Submitted: 1999-08-26
   Days after onset:34
Entered: 1999-08-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0751J / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cerebral haemorrhage, Lymphadenopathy, Oedema, Pyrexia, Vasculitis, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vasculitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-08-08
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: "did not feel well"; something in neck & throat a/ vax
Preexisting Conditions: pharyngeal irritation
Allergies:
Diagnostic Lab Data: cultures all neg
CDC Split Type: WAES99081552

Write-up: p/vax pt exp high fever, vomiting & swollen glands & was hosp;these adverse events were considered life-threatening;8/8/99 pt died;an autopsy was performed & was inconclusive;COD unk;


VAERS ID: 127855 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Kentucky  
Vaccinated:1999-07-06
Onset:1999-07-08
   Days after vaccination:2
Submitted: 1999-08-30
   Days after onset:53
Entered: 1999-09-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462317 / 2 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1100H / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0825 / 2 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Pulmonary oedema, Pyrexia, Sudden infant death syndrome, Unevaluable event, Urticaria
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: 1999-07-10
   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 noted
Preexisting Conditions: none noted (thrush 6/2/99)
Allergies:
Diagnostic Lab Data: autopsy revealed SIDS death
CDC Split Type: KY990039

Write-up: 2day p/vax broke out w/welts on face only; felt warm;welts were on face 3rd day;no meds given;felt warm 3rd night''-10pm;also welts; up 3:10am had bottle;4:45am found dead; no fever noted 3:10am


VAERS ID: 127923 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:1995-05-18
Onset:1998-11-28
   Days after vaccination:1290
Submitted: 1999-02-26
   Days after onset:90
Entered: 1999-09-03
   Days after submission:188
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 370944 / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Acidosis, Apnoea, CSF test abnormal, Cardiac arrest, Coma, Drug ineffective, Hyperglycaemia, Hyperventilation, Hypoxia, Infection, Laboratory test abnormal, Pain, Pyrexia, Sepsis, Skin discolouration, Tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: unknown~ ()~~~In patient
Other Medications: premarin
Current Illness: unk
Preexisting Conditions: Hodgkin''s lymphoma Dx in 1979 w/subsequent splenectomy; hysterectomy w/rt salpingoopherectomy; basal cell carcinoma of chest
Allergies:
Diagnostic Lab Data: glucose-45 mg/dL; CXR-no significant pulmonary infiltrates, no recent trauma; autopsy rpt-adrenal; cerebrospinal & chest skin lesion cultures-pos; serotype S. pneumoniae type 12F; COD-septicemai d/t systemic infect
CDC Split Type: 899060072A

Write-up: devel fever;chills; vomiting & generalized aching;self-medicated w/tylenol; then devel tachycardia;tachypnea;gen mottling, led to unconsciousness;hosp; acidosis, given O2; died;autopsy rpt COD septicemia d/t systemic infect w/S.pneumoniae;


VAERS ID: 127999 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:1998-11-04
Onset:1998-11-05
   Days after vaccination:1
Submitted: 1998-11-05
   Days after onset:0
Entered: 1999-09-03
   Days after submission:301
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 455937 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection, Injection site hypersensitivity, Injection site oedema, Injection site pain, Myocardial ischaemia, Pneumonia, Right ventricular failure
SMQs:, Cardiac failure (narrow), Lack of efficacy/effect (narrow), Pulmonary hypertension (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypersensitivity (narrow), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Norvasc;Propulsid;
Current Illness: NONE
Preexisting Conditions: COPD, HTN, PVD, depression, multi-infarct dementia
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 898313036A

Write-up: p/vax pt devel an inj site rxn characterized by an area of redness, warmth, pain & swelling measuring 3 inches in diameter;pt died of causes unrelated to vax;


VAERS ID: 128054 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Mississippi  
Vaccinated:1999-06-16
Onset:1999-06-20
   Days after vaccination:4
Submitted: 1999-08-30
   Days after onset:71
Entered: 1999-09-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1613A / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Post vaccination syndrome
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS99033

Write-up: COD-changes consistent w/vax related death; Manner of death-consistent w/accident


VAERS ID: 128065 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1999-06-10
Onset:1999-07-22
   Days after vaccination:42
Submitted: 1999-08-06
   Days after onset:15
Entered: 1999-09-07
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1399H / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Ascites, Coordination abnormal, Coronary artery thrombosis, Ear pain, Encephalitis, Generalised oedema, Headache, Hypertonia, Hypokinesia, Infection, Meningitis, Myalgia, Myocarditis, Neck pain, Neuropathy, Otitis externa, Otitis media, Sepsis, Splenomegaly, Thinking abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-08-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MMR & Td in ''98 w/o problem; none
Current Illness: none
Preexisting Conditions: Lorabid & PCN allergies; severe ear infections, usually otitis externa, H/A for many years, controlled w/ ibuprofen; no sz hx
Allergies:
Diagnostic Lab Data: CSF-no growth p/72hr;blood culture-no growth p/48hr; CT-nl; MRI-lt mastoiditis; CSF gram stain smear-mod. segmented WBC-no organisms
CDC Split Type: PA9956

Write-up: pt seen by FMD c/o lt ear pain; dx: otitis externa;7/26 c/o lt ear pain;h/a;off balance;dx OM;tx:Bactrim DS; 7/28-severe h/a,neck pain;difficulty walking;change in mental status,+ Kernig''s sign;hosp;IV Claforan, Vanco, Acyclovir; expired 8/


VAERS ID: 128194 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: California  
Vaccinated:1999-01-08
Onset:1999-01-16
   Days after vaccination:8
Submitted: 1999-09-03
   Days after onset:229
Entered: 1999-09-13
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 4 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-19
   Days after onset: 3
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: n/a
CDC Split Type:

Write-up: 1/16/99 tiredness; sl fever (T not taken); 1/17 inc tiredness; T103-cool bath; 1/18 sluggish behavior; fever up & down 100-103; children''s tylenol; 1/19 approx 3-4am died in sleep


VAERS ID: 128283 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Illinois  
Vaccinated:1999-08-24
Onset:1999-09-05
   Days after vaccination:12
Submitted: 1999-09-14
   Days after onset:9
Entered: 1999-09-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 07521 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiac failure, Coma, Condition aggravated
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (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 (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Digoxin & Lasix
Current Illness: none
Preexisting Conditions: Wolf-Hirschhorn Syndrome (genetic); developmental delay; congential heart defect (w/ Ebstein''s Anomaly); CHF
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found in bed unresponsive on morning of 9/6/99 by mom; paramedics performed resuscitation; pt taken to ER; pronounced dead p/failed resuscitation;


VAERS ID: 128300 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: New York  
Vaccinated:1999-07-08
Onset:1999-08-31
   Days after vaccination:54
Submitted: 1999-09-01
   Days after onset:1
Entered: 1999-09-16
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH - / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Cyanosis, Infection, Rhinitis, Skin discolouration, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-08-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: preemie 34 wk gest w/ vesicostomy d/t urethral obstuction; Apgar 5-7, , hypotension, hyperbilirubinemia to 9 @ birth, intubated d/t abd ascites x3 day then infrequent apnea, bradycardia; cystocopy 8/99, bilateral ureteral stenosis
Allergies:
Diagnostic Lab Data: unkown
CDC Split Type: 899245020A

Write-up: p/vax pt devel congestion & a runny nose; seen by MD who observed pt to be mottled; pale & cyanotic; pt taken to ER & was intubated; attempts at resuscitation unsuccessful; Autopsy revealed urosepsis with E coli bacteria, pyelonephritis, cystitis, hydronephrosis, ureteral stenosis,


VAERS ID: 128767 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1999-06-30
Onset:1999-07-09
   Days after vaccination:9
Submitted: 1999-09-27
   Days after onset:80
Entered: 1999-09-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Anorexia, Apnoea, Brain oedema, Cardiac arrest, Constipation, Injury, Insomnia, Malaise, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-08-07
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: nkda
Allergies:
Diagnostic Lab Data: pyloric ultrasound-nl; upper GI-nl;KUB-neg;UR culture-no growth;galactrosem-below 10mg/dl; HGG type-nl;chest of x-ray
CDC Split Type:

Write-up: projectile vomit;fussy;not eating/sleeping;push fluids;still projectile vomit;fussy;listless;not eating/sleeping;tx:Levsin;no bowel movement;diarrhea;hosp;IV; CPR;cardiac arrest;differential Dx:aspiration;sepsis;SIDS;shaken baby synd


VAERS ID: 129134 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Virginia  
Vaccinated:1999-09-09
Onset:1999-09-29
   Days after vaccination:20
Submitted: 1999-10-04
   Days after onset:5
Entered: 1999-10-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC Split Type:

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


VAERS ID: 129286 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Arkansas  
Vaccinated:1999-09-29
Onset:1999-09-29
   Days after vaccination:0
Submitted: 1999-10-04
   Days after onset:5
Entered: 1999-10-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 909A2 / 2 GM / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 08753 / 2 GM / -

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Agitation, Apnoea, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Cyanosis, Eructation, Hypertrophy, Hyperventilation, Lung disorder, Peripheral vascular disorder, Skin discolouration
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-02
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Zantac, Levsin, Penach
Current Illness: feeding prob-on AVG fdgs/resolved FTT
Preexisting Conditions: NKA, prematurity (31wk), Icthyosis, FTT; hydrocephalus, indwelling NG; family hx of irritable bowel ; child had GI problems, abd pain
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: no fever but fussy since shots;had spell @ 24hr & 40hr p/shots where became poorly perfused (mottled) cold extremities & blue lips;but recovered from both p/20-60min;inc RR, but mom assured secondary to fussiness & gas on belly;


VAERS ID: 129511 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1999-07-08
Onset:1999-09-14
   Days after vaccination:68
Submitted: 1999-10-14
   Days after onset:30
Entered: 1999-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


VAERS ID: 129513 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1999-10-06
Onset:1999-10-09
   Days after vaccination:3
Submitted: 1999-10-13
   Days after onset:4
Entered: 1999-10-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890AL / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0894H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P05522 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Coma, Condition aggravated, Convulsion, Cyanosis, Movement disorder, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: 1999-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Captopril, Lasix, ASA, Reglan, Zantac, Augmentin
Current Illness: mild cough, rt eye chronic folliculitis
Preexisting Conditions: hypoplastic lt heart w/ shunt revision, gastroesophageal reflux, cough, chronic hypoxia;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: mom relates fever on 10/9/99 w/rt sided body movement, then unresponsiveness;seen in ER w/unsuccessful resuscitation;


VAERS ID: 129612 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-10-19
Entered: 1999-10-21
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
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: WAES99100594

Write-up: p/vax pt died from vax;it was noted that there was uncertainty regarding the truthfulness of this claim;


VAERS ID: 129671 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1999-07-10
Onset:1999-07-22
   Days after vaccination:12
Submitted: 1999-10-05
   Days after onset:75
Entered: 1999-10-22
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1399H / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Confusional state, Convulsion, Headache, Hypokinesia, Meningitis, Nuchal rigidity
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-08-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99092260

Write-up: p/vax pt devel h/a, stiff neck & a change in mental status, & was unable to walk;pt hosp;pt devel sz;8/1/99 pt died;initial eval & COD is aseptic meningitis;3 other cases viral meningitis is community during same time frame


VAERS ID: 129684 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Minnesota  
Vaccinated:1999-10-14
Onset:1999-10-15
   Days after vaccination:1
Submitted: 1999-10-19
   Days after onset:4
Entered: 1999-10-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 913A2 / 2 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0461J / 2 - / L
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0473 / 2 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: tube feedings;
Current Illness: NONE
Preexisting Conditions: congential heart disease-NG tube;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: child out of hosp 1wk feeling well, no fever, tube feedings;MD requested update of shots planning surgery;PM to ER for congestive heart failure;02 & sent home but died in sleep late afternoon;no fever or illness r/t vax;


VAERS ID: 129826 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1999-10-06
Onset:1999-10-07
   Days after vaccination:1
Submitted: 1999-10-25
   Days after onset:18
Entered: 1999-10-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0126FA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Lung disorder, Myocardial infarction, Right ventricular failure
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900751

Write-up: p/vax pt found dead by husband on 10/7/99;it was reported by pt husband that on 10/6/99 pt had a cough & chest congestion;pt was never seen by MD not in whole life;pt always treated self w/all kinds of herbs & vitamins;


VAERS ID: 129827 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:1999-10-20
Onset:1999-10-20
   Days after vaccination:0
Submitted: 1999-10-22
   Days after onset:2
Entered: 1999-10-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0096BA / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-20
   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: baclofen IV, morphine sulfate
Current Illness:
Preexisting Conditions: quadriplegic
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900750

Write-up: p/vax pt was found dead by family member;exact time of death has not been established;autopsy to determine COD is being conducted 10/21/99;


VAERS ID: 129991 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:1999-10-19
Onset:1999-10-20
   Days after vaccination:1
Submitted: 1999-10-27
   Days after onset:7
Entered: 1999-10-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0096BA / 2 - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~~In patient
Other Medications: insulin, Pepcid
Current Illness: none x/ feeling tired
Preexisting Conditions: IDDM, poorly controlled; Arteriosclerotic disease w/ angina; elev cholesterol; frequent URI & UTI; diverticulitis; hiatal hernia; breast CA s/p lumpectomy in ''92-in remission
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900765

Write-up: p/vax pt was found dead;it it unk if an autopsy is being performed;


VAERS ID: 130028 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:1999-10-21
Onset:1999-10-22
   Days after vaccination:1
Submitted: 1999-10-22
   Days after onset:0
Entered: 1999-10-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998221 / 1 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Cardiac arrest, Coronary artery disease, Hypertension, Lung disorder, Right ventricular failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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), Pulmonary hypertension (narrow), Hypertension (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: ProAmatine, Cozaar, Dyazide; Pepcid, Carafate, Albutrol;
Current Illness: NONE
Preexisting Conditions: NKDA;CHF, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax @ clinic 10/21/99 & deceased @ home 10/22/99;


VAERS ID: 130318 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:1999-10-12
Onset:1999-10-19
   Days after vaccination:7
Submitted: 1999-10-28
   Days after onset:9
Entered: 1999-11-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998212 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 3030320OCT199

Write-up: p/vax pt devel resp arrest & died;it was reported that medical director felt there was no connection between vax & events;


VAERS ID: 130605 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1999-10-07
Onset:1999-10-08
   Days after vaccination:1
Submitted: 1999-11-03
   Days after onset:26
Entered: 1999-11-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0065AA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypoxia, Pharyngitis, Pulmonary fibrosis, Pulmonary oedema, Respiratory disorder
SMQs:, Cardiac failure (narrow), Agranulocytosis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-18
   Days after onset: 41
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: Celestone, Ceftin, Proventil HAM, histex HC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgical pathology from lt lung biopsy on 10/28/99-diffuse alveolar damage w/acute & chronic penumonitis, hyaline membrane formation, interstitial edema & early organization;
CDC Split Type: U199900836

Write-up: p/vax pt exp a severe sore throat that became worse p/ATB;CXR revealed bilat pulmonary infiltrates;pt put on ventilator;pt had an open lung biopsy on10/28''/99;tissue samples show diffuse alveolar damage w/acute & chronic pneumonitis;60 day follow up states the pt died.


VAERS ID: 130608 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Kentucky  
Vaccinated:1999-10-01
Onset:1999-10-13
   Days after vaccination:12
Submitted: 1999-11-04
   Days after onset:22
Entered: 1999-11-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0907H / 4 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0998H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal distension, Apnoea, Blood thromboplastin decreased, Blood urea increased, Cardiac arrest, Cyanosis, Infection, Laboratory test abnormal, Pain, Prothrombin level decreased, Pyrexia, Thrombocytopenia
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: chemistry-BUN 36, CR 0.8, aGT 162, LDH 4054;aridocid 9.1;paltelets 90,000;PT/PTT 18.1/39.4;abrinogan 382;bil 1.8;
CDC Split Type: KY990052

Write-up: pt adm to hosp 10/13/99 w/fever, leg pain, abd distention & leg purple;dx Beta-hem, streptococci group A invasion.-transported to hosp; complications; cardiopulmonary arrest;


VAERS ID: 130869 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:1999-10-11
Onset:1999-10-20
   Days after vaccination:9
Submitted: 1999-11-05
   Days after onset:16
Entered: 1999-11-15
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0132AA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
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: 1999-11-01
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy report is pending;
CDC Split Type: U199900862

Write-up: p/vax pt dx w/pneumonia;pt expired on 11/1/99;MD does not feel what occurred is r/t vax;


VAERS ID: 130888 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maryland  
Vaccinated:1999-11-12
Onset:1999-11-13
   Days after vaccination:1
Submitted: 1999-11-18
   Days after onset:5
Entered: 1999-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464306 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0553 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Bacterial infection, Cardiac arrest, Haemorrhage intracranial, Hepatocellular damage, Lung disorder, Pulmonary oedema, Spleen disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (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), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: post mortem exam, results pending; toxicologic analyses-neg; 12/27/99 Neurology report showed an old subdural hemorrhage (may be secondary to trauma during birth)
CDC Split Type: MD99028

Write-up: death, found in crib attempted; resuscitation unsuccessful. Rcv''d missing info report 1/3/00. ME will send final report when completed. He is still working on preliminary cause of death (unsure at this time). COD -- Myocarditis as per autopsy report; Lungs-congestion and edema with multiple macrophages in the alveolar spaces; some bronchioles and alveolar spaces contain a yellow pigmented foreign material and scattered coccal bacteria without inflammatory reaction; liver-congestion and extra-medullary hematopoiesis; spleen-congestion; thymus-few petechial hemorrhages; heart-scattered foci of chronic inflammation with myocyte necrosis; 1 multinucleated giant cell is present


VAERS ID: 130935 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Indiana  
Vaccinated:1999-11-09
Onset:1999-11-10
   Days after vaccination:1
Submitted: 1999-11-10
   Days after onset:0
Entered: 1999-11-19
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 888A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0257J / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 06572 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Augmentin day a/vax; had allerg rxn
Current Illness: upper resp infect; rash from Augmentin
Preexisting Conditions: allergy to Augmentin
Allergies:
Diagnostic Lab Data: autopsy performed;
CDC Split Type:

Write-up: pt was found deceased in bassinet;time of death called @ 1232; pt was alive @ 1130


VAERS ID: 131045 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:1999-10-05
Onset:1999-10-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1999-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 49998293 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Coagulopathy, Hypoxia, Infection, Pneumonia, Pyrexia, Respiratory disorder
SMQs:, Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-10-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: chronic vertigo
Preexisting Conditions: HTN;Hypothyroidism;Iron def anemia;
Allergies:
Diagnostic Lab Data: 10/25/99 positive viral cult for influenza A from a bronchial washing;
CDC Split Type:

Write-up: p/vax pt c/o T103.8 & shaking chills;refused hosp adm;T104.6 R;adm to hosp;10/14/99 CXR showed ARDS & pneumonia;pt placed on ventilator;devel DIC;pt expired 10/25/99;


VAERS ID: 131449 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1999-10-11
Onset:1999-10-24
   Days after vaccination:13
Submitted: 1999-11-03
   Days after onset:10
Entered: 1999-11-29
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U011AB / 7+ LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: 2 types insulin, synthroid, antidepressants-buspar;anapheril, Ritalin, flexaril, melatonin
Current Illness: NONE; blood sugar nl 10/23, 10PM
Preexisting Conditions: diabetes (for 37 years), Graves disease (for 20yrs), diabetic depression
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA9924

Write-up: pt was found dead 12.5 days p/vax;


VAERS ID: 131452 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1999-11-04
Onset:1999-11-07
   Days after vaccination:3
Submitted: 1999-11-15
   Days after onset:8
Entered: 1999-11-29
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0167AA / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / 1 RL / -

Administered by: Public       Purchased by: Unknown
Symptoms: Asphyxia, Convulsion, Injury
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: phenobarbital;
Current Illness: NONE
Preexisting Conditions: lissencephaly, microcephaly, sz disorer;
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA991103

Write-up: pt expired 11/7/99-COD accidental asphyxiation d/t lissencephaly, microcephaly;


VAERS ID: 131636 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New York  
Vaccinated:1999-11-02
Onset:1999-11-03
   Days after vaccination:1
Submitted: 1999-11-03
   Days after onset:0
Entered: 1999-12-02
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464303 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P06572 / 2 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Abscess, Sepsis, Urinary tract infection
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin;MS Prophylaxis
Current Illness: NONE
Preexisting Conditions: hydronephronsis lt kidney-had urological surg 10/6/99
Allergies:
Diagnostic Lab Data: autopsy revealed the cause of death to be sepsis secondary to UTI and abscess.
CDC Split Type:

Write-up: pt died next Am in bed but at autopsy had large abscess @ bladder & surgical incision site from urological surgery 10/6/99;


VAERS ID: 131642 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Minnesota  
Vaccinated:1999-10-26
Onset:1999-11-12
   Days after vaccination:17
Submitted: 1999-11-15
   Days after onset:3
Entered: 1999-12-02
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U1032AA / 5 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Convulsion, Encephalitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (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: 1999-11-15
   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: APAP, carbamazepine
Current Illness:
Preexisting Conditions: 30wk prematurity, triplet, mild BPD-resolved; hx of seizures, hx of encephalitis, bronchitis
Allergies:
Diagnostic Lab Data: nasopharyngeal culture 11/14/99: parainfluenzavirus type I
CDC Split Type:

Write-up: brainstem & cerebellar edema leading to brain death adm 11/12/99 w/nl LP, MRI;f/u MRI 11/14/ brainstem, cerebellar edema prior hx of CNS problems p/last year''s vax also;acute demyelinating encephalomyelitis 10/98 w/bilat temporal lobe; Autopsy stated final diagnosis of seizure and fever,


VAERS ID: 132108 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1999-10-19
Onset:1999-10-24
   Days after vaccination:5
Submitted: 1999-11-01
   Days after onset:8
Entered: 1999-12-06
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0998410 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1920H / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0825 / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9984

Write-up: p/vax pt died from apparent SIDS on10/24/99;parents stated pt had no reaction from immunizations


VAERS ID: 132111 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:1999-11-26
Onset:1999-11-27
   Days after vaccination:1
Submitted: 1999-11-30
   Days after onset:3
Entered: 1999-12-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0962260 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1522J / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 458728 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P02422 / 1 - / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-11-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: resp distress, pneumothonax, PDA, Apnea, anemia, thrombocytopenia, hypotension;
Preexisting Conditions: resp distress, pneumothrax, PDA, Apnea, Anemia, thrombocytopenia, hypotens, candida UTi, penumonia;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt devel fever, initially low grade, then 104 by 11/29/99 AM;APAP q 4hr beginning w/vax;


VAERS ID: 132114 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arizona  
Vaccinated:1998-06-16
Onset:1998-06-19
   Days after vaccination:3
Submitted: 1999-11-29
   Days after onset:528
Entered: 1999-12-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0007H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N014762 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hep B @ birth 4/23/98
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt found dead on side 5-8min p/being layed down for a morning nap;parent believe child death poss r/t vax;parents states did not fit any of SIDS risk factors x/had vax;


VAERS ID: 132241 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Tennessee  
Vaccinated:1999-11-02
Onset:1999-11-20
   Days after vaccination:18
Submitted: 1999-12-02
   Days after onset:12
Entered: 1999-12-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER U008CA / 2 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0610J / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER PO168 / 2 LA / SQ

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: pt devel fever 105, fussy;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: gastroesophageal reflux;colic
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TN99053

Write-up: SIDS;


VAERS ID: 132243 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1999-10-05
Onset:1999-10-08
   Days after vaccination:3
Submitted: 1999-11-13
   Days after onset:36
Entered: 1999-12-07
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0063AA / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Condition aggravated, Hypoxia, Lung disorder, Respiratory disorder, Right ventricular failure, Sepsis, Shock, Urinary tract disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-12-09
   Days after onset: 62
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: polyarythemia/myclofibrodysplastia;cardiomyopathy
Allergies:
Diagnostic Lab Data: extemsive
CDC Split Type:

Write-up: resp failure-ventilator support;aspiration;prob septic shock;CHF;60 day follow-up / states the pt died. The pt developed renal and pulmonary disorders and had to be intubated, was dialyzed before he died.


VAERS ID: 132541 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1999-11-19
Onset:0000-00-00
Submitted: 1999-12-10
Entered: 1999-12-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 912A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1381J / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N1062 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-20
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: viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Medical examiner verbally stated child died from SIDS. Mother is blaming on immunizations that child received.Mother states child was very tired & slept until next am,at time of death child''s rectal temp was 106.


VAERS ID: 132499 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1999-11-11
Onset:1999-11-12
   Days after vaccination:1
Submitted: 1999-12-08
   Days after onset:26
Entered: 1999-12-20
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464300 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0257J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/11/99, noted to have URI, was immunized - pt remained playful, and well hydrated.11/12 pt. was fussy in am, gave bottle and put on couch to nap.45 min later not breathing taken to ER. Resusc. unsuccessl, Dx full arrest. Suspect SIDS.


VAERS ID: 132820 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1999-11-30
Onset:1999-12-01
   Days after vaccination:1
Submitted: 1999-12-08
   Days after onset:7
Entered: 1999-12-27
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0688J / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: jaundice wt at 1 mo check-up 11.7
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL99086

Write-up: Child was being watched by grandmother who reported that the child was shaking earlier in the evening. Child was put in his crib on his back and later was found on his stomach; blue around the mouth but still warm. SIDS suspected.


VAERS ID: 132821 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: Illinois  
Vaccinated:1999-11-22
Onset:1999-11-26
   Days after vaccination:4
Submitted: 1999-12-14
   Days after onset:18
Entered: 1999-12-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 052281A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES UA071AA / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Brain oedema, Confusional state, Dyspnoea, Febrile convulsion, Hypoxia, Pyrexia, Stupor, Subarachnoid haemorrhage
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), 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: 1999-12-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT of head:central herniation,cerebral edema.EEG:low applitude.MRI of brain:thalamus,temporal lobes ischemic.Autopsy results pending.
CDC Split Type: U199901040

Write-up: 11/22/99:pt. rcvd vacc.11/30/99:Pt. dvlped fever,chills,SOB, confusion,& less responsive.12/1/99:EMS called,pt.had fever of 105 and began seizing.In hospital, pt. dxed w/ central herniation and cerebral edema.12/2/99:pt pronounced dead.


VAERS ID: 133040 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New Hampshire  
Vaccinated:1999-04-15
Onset:1999-04-17
   Days after vaccination:2
Submitted: 1999-12-22
   Days after onset:249
Entered: 2000-01-05
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 865A2 / 2 - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0992660 / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0699 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: thrush
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9927

Write-up: SIDS


VAERS ID: 132417 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1999-10-18
Onset:0000-00-00
Submitted: 1999-11-29
Entered: 2000-01-06
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 031779P / UNK RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY990062

Write-up: Death due to CHF, no autopsy.


VAERS ID: 133171 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1997-06-10
Onset:1997-06-25
   Days after vaccination:15
Submitted: 2000-01-03
   Days after onset:922
Entered: 2000-01-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444382 / UNK - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M300 / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER M0443 / UNK - / SC

Administered by: Private       Purchased by: Private
Symptoms: Crying, Eczema, Grand mal convulsion, Injection site oedema, Rhinitis, Screaming
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), 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), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-12-05
   Days after onset: 1259
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: clear runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG,MRI,CT,metabolic screenings showing no abnormalities
CDC Split Type:

Write-up: First night following vax,pt had swelling at inj site & high-pitched screaming for hrs.2 wks later,began having complex partial seizures.7 wks later,began having prolonged seizures on reg. basis.She is severely delayed & dvlped eczema. Annual followup indicates pt died on 12/5/2000. She continued to have serious seizures and developmental delays and sensory integration problems. Her seizures stopped for almost 2 years with the ketogenic diet. Then they started again and she had her last big one, her brain swelled and she died.


VAERS ID: 133221 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1999-12-07
Onset:1999-12-23
   Days after vaccination:16
Submitted: 1999-12-28
   Days after onset:5
Entered: 2000-01-12
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 400400A / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3024A2 / 1 LL / SC
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0764 / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Bronchiolitis, Infection, Sudden infant death syndrome
SMQs:, Interstitial lung disease (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: RSV Bronchiolitis-admit 11/23;discharged 11/25
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found unresponsive-dead.


VAERS ID: 133222 (history)  
Form: Version 1.0  
Age: 0.12  
Sex: Female  
Location: California  
Vaccinated:1998-05-22
Onset:1998-05-23
   Days after vaccination:1
Submitted: 1998-12-14
   Days after onset:205
Entered: 2000-01-12
   Days after submission:394
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 447789 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2500A2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 772K2 / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Rash, Shock, Somnolence
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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: diaper rash
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced fever 1 hr after receiving vax.24 hrs after vax, pt experienced shock; seemed very distant-all attentiveness disappeared.29 hrs after vax, pt was excessively sleepy.31 hrs after vax, pt died.


VAERS ID: 133265 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1999-12-15
Onset:1999-12-21
   Days after vaccination:6
Submitted: 1999-12-30
   Days after onset:9
Entered: 2000-01-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / UNK LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1618H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0657 / UNK LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy results pending
CDC Split Type:

Write-up: Respiratory problems all night then found cyanotic.


VAERS ID: 133689 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Female  
Location: New York  
Vaccinated:1998-10-28
Onset:1998-10-30
   Days after vaccination:2
Submitted: 2000-01-02
   Days after onset:429
Entered: 2000-02-02
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1605E / 3 RL / IM

Administered by: Public       Purchased by: Other
Symptoms: Acute lymphocytic leukaemia, Anaemia, Apnoea, Ascites, Blood fibrinogen decreased, Blood thromboplastin decreased, Capillary fragility increased, Cardiovascular disorder, Cough, Cyanosis, Diarrhoea, Dyspnoea, Hypothermia, Leukopenia, Mydriasis, Platelet disorder, Prothrombin level decreased, Pulmonary oedema, Pyrexia, Renal impairment, Sepsis, Shock, Skin discolouration, Somnolence, Spleen disorder, Tachycardia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Haematological malignant tumours (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: Occassional cough
Preexisting Conditions: Allergy-Imipeium, Leukemia (ALL) in remission, some splenic dysfunction
Allergies:
Diagnostic Lab Data: High PT, PTT, IRBR, dec platelets & firbinogen, anemic, dec WBC.
CDC Split Type:

Write-up: Fever, rigors.Vomiting,1 diarrhea stool,resp distress,


VAERS ID: 133751 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1999-05-27
Onset:1999-06-12
   Days after vaccination:16
Submitted: 2000-01-05
   Days after onset:207
Entered: 2000-02-07
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2948A2 / 1 - / 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: 1999-06-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9928

Write-up: SIDS


VAERS ID: 133836 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:1999-11-29
Onset:1999-12-24
   Days after vaccination:25
Submitted: 2000-01-28
   Days after onset:35
Entered: 2000-02-09
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0104AA / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0043J / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Guillain-Barre syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Respiratory failure (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-05-22
   Days after onset: 149
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Norvase, Dilantin
Current Illness: NONE
Preexisting Conditions: Seizure disorder, HTP
Allergies:
Diagnostic Lab Data: + CP and FMG
CDC Split Type:

Write-up: Pt was dx w/ Guillian-Barre. Cause of death given as cardiac arrest.


VAERS ID: 133879 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: New York  
Vaccinated:1997-10-31
Onset:1997-11-01
   Days after vaccination:1
Submitted: 2000-01-02
   Days after onset:792
Entered: 2000-02-11
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444250 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autopsy- unk, possibly SIDS.
CDC Split Type: HQ0824201FEB2000

Write-up: SIDS. 1st Acel-Imune 10/31/97. Nov 1st infant died. Autopsy stated cause of death unk, possibly SIDS.


VAERS ID: 133895 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2000-01-25
Onset:2000-02-01
   Days after vaccination:7
Submitted: 2000-02-04
   Days after onset:3
Entered: 2000-02-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Encephalopathy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


VAERS ID: 133896 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Colorado  
Vaccinated:2000-01-13
Onset:2000-01-16
   Days after vaccination:3
Submitted: 2000-01-27
   Days after onset:11
Entered: 2000-02-14
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1411J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01673 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Bacterial infection, Pulmonary oedema, Sepsis
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-01-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nystatin
Current Illness: mild resolving viral URI
Preexisting Conditions: Probably alpha thalasemia trait, per newborn screen
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Sudden death (probable SIDS - coroners report pending) 2 1/2 days post immunization, child was fine between the vax and unexpected death. I doubt this is related to the vaccines, but wanting to be thorough.


VAERS ID: 134066 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Unknown  
Vaccinated:1999-04-29
Onset:1999-04-29
   Days after vaccination:0
Submitted: 2000-02-01
   Days after onset:278
Entered: 2000-02-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Apnoea, Asthenia, Cardiac arrest, Convulsion, Leukocytosis, Malaise, Pallor, Pneumonia, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-05-02
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR,EKG,blood culture, EEG,cranial ultrasound=all normal; WBC-20,000
CDC Split Type:

Write-up: Pt recv''d vax on 4/29/99. When mother was putting child to sleep she noticed the child was not breathing. She blew in child''s face & he resumed respirations. Child cont to be lethargic,weak,& crying for 45 mins. Came to ER & dxed w/ poss


VAERS ID: 134070 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Ohio  
Vaccinated:2000-01-04
Onset:2000-01-07
   Days after vaccination:3
Submitted: 2000-01-11
   Days after onset:4
Entered: 2000-02-15
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / 3 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold
Preexisting Conditions: RDS, history of seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH00002

Write-up: Infant found not breathing, no pulse. Death certificate lists cause of death as SIDS, autopsy revealed no abnormalities.


VAERS ID: 134071 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1999-12-07
Onset:1999-12-28
   Days after vaccination:21
Submitted: 2000-01-31
   Days after onset:34
Entered: 2000-02-15
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 912A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0672J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P05522 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy revealed that the cause of death was SIDS.
CDC Split Type: OH00003

Write-up: Infant found not breathing and without a pulse by mother. Autopsy revealed that the cause of death was SIDS.


VAERS ID: 134072 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Ohio  
Vaccinated:2000-01-25
Onset:2000-01-31
   Days after vaccination:6
Submitted: 2000-02-01
   Days after onset:1
Entered: 2000-02-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1477J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P06582 / 2 RL / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: autopsy revealed cause of death to be SIDS.
CDC Split Type: OH00004

Write-up: Baby found not breathing at baby-sitter''s. Resuscitation efforts to no avail.


VAERS ID: 134118 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Hawaii  
Vaccinated:2000-01-24
Onset:2000-01-31
   Days after vaccination:7
Submitted: 2000-02-02
   Days after onset:2
Entered: 2000-02-16
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1523J / 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: 2000-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy revealed the probable cause of death to be SIDS.
CDC Split Type:

Write-up: Child died of apparent SIDS 7 days after Hep B vax was administered.


VAERS ID: 134249 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2000-02-08
Onset:2000-02-13
   Days after vaccination:5
Submitted: 2000-02-14
   Days after onset:1
Entered: 2000-02-29
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0837J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N09501 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: natural mom used drugs during pregnancy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Recv''d vax on 2/8/00. Foster mom found infant dead Sunday am on 2/13/00. Pt autopsied. Preliminary COD is SIDS.


VAERS ID: 134250 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1999-12-16
Onset:1999-12-20
   Days after vaccination:4
Submitted: 2000-01-20
   Days after onset:31
Entered: 2000-02-29
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045CA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 01082 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES U1144AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0258 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead by parent on 12/20/99 at 10:03. Autopsy gave cause of death as sudden infant death syndrome, pulmonary congestion.


VAERS ID: 134334 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-02-17
Entered: 2000-02-29
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / IM
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: bone marrow transplant
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00020837

Write-up: Pt recv''d Pneumovax,meningococcal, & ACTHIB vax. Subsequently, pt exp stroke-like symptoms. Pt sought unspecified medical attention. (OMIC)


VAERS ID: 134498 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-03-01
Entered: 2000-03-03
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 2 - / -

Administered by: Public       Purchased by: Other
Symptoms: Arteriosclerosis, Arthritis, Depression, Hypertrophy, Lung disorder, Neuropathy, Pain, Suicide attempt
SMQs:, Peripheral neuropathy (narrow), Suicide/self-injury (narrow), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (narrow), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000054921

Write-up: In March & April of 1999, pt rcv''d injections of Lymerix.He exp debilitating pain which required him to use crutches. He also began to exp arthritic & neurologic symptoms. Allegedly, after 14 dr & no dx reached the pt committed suicide. Autopsy shows final diagnosis of heart, left ventricular hypertrophy, aortic atherosclerosis, lung congestion, pancreas, autolysis, depression, committed suicide by hanging.


VAERS ID: 134548 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-02-26
Entered: 2000-03-06
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Encephalitis
SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00021774

Write-up: Approximately two weeks post vaccination, the pt experienced acute demyelinating encephalomyelitis. The pt deteriorated rapidly and died. The cause of death was encephalomyelitis. An autopsy was performed, but the brain was liquified.


VAERS ID: 134574 (history)  
Form: Version 1.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1999-11-01
Onset:1999-11-14
   Days after vaccination:13
Submitted: 2000-02-25
   Days after onset:103
Entered: 2000-03-07
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Cellulitis, Dermatitis bullous, Muscle twitching, Pneumonia, Sepsis, Somnolence
SMQs:, Severe cutaneous adverse reactions (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-12-12
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic renal failure, DM, cirrhosis
Preexisting Conditions: Hx: CRF, mental retardation, Tenkhoff for CAPD, DM type 2.
Allergies:
Diagnostic Lab Data: Viral culture not done of vesicle fluid
CDC Split Type:

Write-up: 11/14 admitted w/ lethargy. 11/14 cellulitis restricted to legs bilateral. 11/21 devel vesicles/pustules trunk, thighs, legs. Pt subsequently died due to pneumonia and sepsis. No autopsy was performed.


VAERS ID: 134575 (history)  
Form: Version 1.0  
Age: 50.0  
Sex: Female  
Location: Kansas  
Vaccinated:1999-10-20
Onset:1999-10-21
   Days after vaccination:1
Submitted: 2000-03-02
   Days after onset:133
Entered: 2000-03-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0155AA / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-12
   Days after onset: 22
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: Being considered for liver transplant.
Preexisting Conditions: Hx: Hep B, Hep C, Cirrhosis of liver.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sister of pt stopped by clinic to pay for vax. Stated that flu shot caused sister''s death. Began to feel ill next day. Transported to ER on 11/12 by ambulance, died few hrs later. Stated pt didn''t see MD between 10/20 & 11/12/99.


VAERS ID: 134577 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:2000-03-02
Onset:2000-03-03
   Days after vaccination:1
Submitted: 2000-03-04
   Days after onset:1
Entered: 2000-03-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467012 / 2 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0051K / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P12323 / 2 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Pulmonary oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxcillin, Pediacare
Current Illness: otitis media/URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy revealed pulmonary and cerebral edema. Cause of death determined to be SIDS.
CDC Split Type:

Write-up: Pt found dead in sleep.


VAERS ID: 134583 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Florida  
Vaccinated:2000-02-29
Onset:2000-03-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2000-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3205A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3205A2 / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P1232 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child received multiple injections 2/29/00. Mom put child to bed around 11:15 PM on 2/29/00 on the floor on 2 soft pillows. Did not check on the infant until around 9:00 AM on 3/1/00. Found child deceased.


VAERS ID: 134672 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:2000-01-12
Onset:2000-01-17
   Days after vaccination:5
Submitted: 2000-01-19
   Days after onset:2
Entered: 2000-03-09
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D006R / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3201A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 520453 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. PO168 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-01-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: 00TX009

Write-up: No signs, no symptoms, found dead at 3 AM 1/17/00. Autopsy findings (per grandmother) stated that infant died of SIDS. Grandmother interviewed by phone.


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

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=16&PERPAGE=100&DIED=Yes


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