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VAERS ID: 150074 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Virginia  
Vaccinated:2000-03-11
Onset:2000-03-12
   Days after vaccination:1
Submitted: 2000-03-13
   Days after onset:1
Entered: 2000-03-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


VAERS ID: 150145 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2000-01-19
Submitted: 2000-03-13
   Days after onset:54
Entered: 2000-03-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Bacterial infection, Pneumonia, Sepsis
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-01-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Hodgkin''s disease (NOS), Vitamin B12 deficiency, Splenectomy
Allergies:
Diagnostic Lab Data: Blood culture (+) strep pneumonia-1/19/00
CDC Split Type: HQ1509410MAR2000

Write-up: A pt received an injection of pneumococcal vax and subsequently died. No further information was available at the date of this report. Follow-up reports a dx of pneumonia and sepsis. Cause of death was reported as "septic shock associated with pneumococcal bacteremia".


VAERS ID: 150155 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1999-11-15
Onset:1999-11-20
   Days after vaccination:5
Submitted: 2000-03-08
   Days after onset:109
Entered: 2000-03-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hallucination, Headache
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


VAERS ID: 150156 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: South Dakota  
Vaccinated:0000-00-00
Onset:1997-03-01
Submitted: 2000-03-03
   Days after onset:1098
Entered: 2000-03-17
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-10
   Days after onset: 649
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lung cancer developed in early 50''s. He did not smoke. Died of cancer treatment. Suspect connection to Rhesus polio vaccine


VAERS ID: 150185 (history)  
Form: Version 1.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:1995-03-01
Onset:1995-04-01
   Days after vaccination:31
Submitted: 2000-03-15
   Days after onset:1810
Entered: 2000-03-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abasia, Arthralgia, Arthritis, Autoimmune disorder, Blood creatine phosphokinase increased, Connective tissue disorder, Dyspnoea, Respiratory failure, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (narrow), Respiratory failure (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-04-29
   Days after onset: 1854
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Antibiotics
Current Illness: MTI - malignant teratoma intermediate
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CPK - severely elevated.
CDC Split Type:

Write-up: Pt began suffering pain in her joints shortly after receiving vax. Dx as arthritis, then connective tissue disorder, then auto immune deficiency. She had trouble breathing, can''t walk. The pt died on 4/29/00, no autopsy will be performed. Per the death certificate the pt''s cause of death was septic shock and respiratory failure.


VAERS ID: 150243 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-03-07
Onset:2000-03-11
   Days after vaccination:4
Submitted: 2000-03-13
   Days after onset:2
Entered: 2000-03-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388BA / 4 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG314009 / 4 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0548AA / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0473 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0928J / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Atelectasis, Brain oedema, Convulsion, Foetal disorder, Hyperplasia, Liver disorder, Petechiae, Pulmonary congestion, Pulmonary oedema, Renal disorder, Spleen disorder, Tremor
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Foetal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy to be performed
CDC Split Type: MS00007

Write-up: No reaction or illness was noted after vaccine until the morning of 3/11/00. The child was playing and then laid down on couch and started shaking and stopped breathing. Autopsy showed cause of death to be consistent with seizure. Other findings of pulmonary vascular congestion and edema, atelectasis of the lungs, hepatic congestion, petechiae of the thymus, splenic congestion, reactive lymphoid hyperplasia of the mesenteric lymph nodes, renal congestion, fetal lobulation of the kidneys, cerebal edema.


VAERS ID: 150249 (history)  
Form: Version 1.0  
Age: 0.03  
Sex: Female  
Location: New Jersey  
Vaccinated:2000-02-28
Onset:2000-03-03
   Days after vaccination:4
Submitted: 2000-03-15
   Days after onset:12
Entered: 2000-03-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Brain oedema, Pulmonary oedema, Sudden infant death syndrome
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autopsy revealed cerebral edema and pulmonary edema. Cause of death determined to be SIDS.
CDC Split Type: WAES00030691

Write-up: Information has been received from a health care professional concerning a 7 day old female pt, who on 2/28/2000, was vaccinated with the first dose of Hepatitis-B vaccine recombinant (yeast). On 3/3/2000, the child expired. The cause of death was unknown. The medical examiner did determine that no congenital anomaly was determined. Follow-up information received from a registered nurse indicated that the suspected cause was sudden infant death syndrome, although the final autopsy results were not available, there were no gross anatomical abnormalities. The nurse stated that


VAERS ID: 150474 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Montana  
Vaccinated:2000-03-16
Onset:2000-03-17
   Days after vaccination:1
Submitted: 2000-03-21
   Days after onset:4
Entered: 2000-03-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-17
   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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC Split Type:

Write-up: Accidental suffocation 24 hours post vax.


VAERS ID: 150475 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Illinois  
Vaccinated:2000-03-15
Onset:2000-03-17
   Days after vaccination:2
Submitted: 2000-03-29
   Days after onset:12
Entered: 2000-03-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC Split Type:

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


VAERS ID: 150596 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2000-02-09
Onset:2000-02-09
   Days after vaccination:0
Submitted: 2000-03-28
   Days after onset:48
Entered: 2000-03-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 463727 / 1 - / -

Administered by: Private       Purchased by: Other
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
   Days after onset: 6
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: HQ1812624MAR2000

Write-up: Pt with a history of multiple myeloma received injections of Pnu-Imune 23, Act-HIB (Aventis Pasteur SA) and Menomune-a/c/y/w 135 (Aventis Pasteur Inc) vaccines on 9-FEB-2000. Later that day he experienced "stroke-like symptoms" and was brought to emergency room. After extensive testing it was determined he had an embolic stroke and the reporter did not feel it was related to the vaccines.


VAERS ID: 150618 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Arizona  
Vaccinated:2000-03-15
Onset:0000-00-00
Submitted: 2000-03-29
Entered: 2000-03-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7316BB / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 3 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0444 / 3 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Coma, Pneumonia, Pulmonary congestion, Pulmonary oedema, Unevaluable event
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-27
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: Exposure to Hep B at birth
Allergies:
Diagnostic Lab Data: autopsy-pending
CDC Split Type:

Write-up: No adverse reaction to immunizations. Unknown states "as far as we know, pt did not have reaction (fever etc). Infant given a bottle and put down for nap. Later the babysitter found the baby unresponsive. Autospy states cause of death as pneumonia. Autopsy also shows pulmonary edema and congestion.


VAERS ID: 150733 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-07-01
Onset:1995-06-07
   Days after vaccination:341
Submitted: 2000-03-30
   Days after onset:1758
Entered: 2000-04-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Apathy, CSF test abnormal, Coma, Confusional state, Crying, Dysarthria, Dystonia, Electroencephalogram abnormal, Encephalitis, Hyperreflexia, Myoclonus, Speech disorder, Tachycardia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: EEG-periodic high-voltage generalized sharp waves, CSF measles IgG titer-160 units, CSF measles IgG index-3.7, HIV-neg
CDC Split Type: WAES00032144

Write-up: Post vax, the pt presented with progressive confusion, crying spells, and social withdrawal. Three months after symptom onset, he developed intermittent dystonic posturing of the left arm and leg. Initial neurological exam was significant for dysarthria and myoclonus of the left arm and leg. During the fourth month of illness, the pt developed hyperreflexia, and extensor plantar responses. By the fifth month, the myoclonus ceased. He became unresponsive, mute, and displayed intermittent hyperreflexia and tachycardia suggesting autonomic dysfunction. He expired six months after the onset of symptoms. An autopsy was refused. The cause of death was subacute sclerosing panencephalitis. Information about this case is described in an unpublished manuscript entitled "Subacute sclerosing panencephalitis in US born adult".


VAERS ID: 150874 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:2000-04-06
Onset:2000-04-06
   Days after vaccination:0
Submitted: 2000-04-07
   Days after onset:1
Entered: 2000-04-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC Split Type:

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


VAERS ID: 150875 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Indiana  
Vaccinated:1999-08-27
Onset:1999-09-01
   Days after vaccination:5
Submitted: 2000-03-06
   Days after onset:187
Entered: 2000-04-10
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-09-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC Split Type:

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


VAERS ID: 150892 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: California  
Vaccinated:1997-11-01
Onset:1998-08-01
   Days after vaccination:273
Submitted: 2000-04-04
   Days after onset:612
Entered: 2000-04-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Brain neoplasm, Laboratory test abnormal, Viral infection
SMQs:, Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-31
   Days after onset: 183
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: Virus tissue specimen test positive 4/25/02: microscopic examination of brain tissue containing foci of round poorly differentiated tumor cells. Results: tumor tissue: very strong band visualized. Fooled section of the adjacent brain tissue were negative for SV40 sequences. Interpretation: DNA sequences specific for SV40, were present in the tumor cells but were absent in the adjacent non-malignant brain tissue. Autopsy results: medulloblastoma
CDC Split Type: HQ2032103APR2000

Write-up: Pt received vax in November 1997. In August 1998, pt allegedly was diagnosed with medulloblastoma. Allegedly the pt underwent two surgeries to remove the tumor and was administered chemotherapy. On 1/31/99, he died. Allegedly his brain tissue revealed the presence of Simian Virus-40. Additional info received on 2/24/03 from attorney for consumer contained one physician''s pathology analysisi of brain tissue. A legal complaint was received from an attorney alleging that a 25 month old male recieved Orimune in November 1997 that was "improperly manufactured and which contained contaminants including, but not limited to SV40 which caused the development of brain tumors that ultimately were a direct and proximate cause of his death." The child was diagnosed with medulloblastoma in August 1998. According to the legal complaint, the pt underwent two surgeries to remove the tumor and was administered chemotherapy. On 1/31/99, he died. On 4/25/02, a microscopic examination of brain tissue revealed DNA sequences specific for Simian Virus-40 (SV40) present in the tumor cells but they were absent in the adjacent non-malignant brain tissue.


VAERS ID: 150931 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-03-31
Onset:2000-04-01
   Days after vaccination:1
Submitted: 2000-04-04
   Days after onset:2
Entered: 2000-04-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 40040CA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Pt was well and went to sleep at approximately 10:30 pm. Found at 6:00 am not breathing. Pt had been put to sleep on her side but was found on stomach.


VAERS ID: 150974 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: Washington  
Vaccinated:2000-03-29
Onset:2000-04-02
   Days after vaccination:4
Submitted: 2000-04-05
   Days after onset:2
Entered: 2000-04-17
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


VAERS ID: 151082 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2000-03-27
Onset:2000-03-29
   Days after vaccination:2
Submitted: 2000-04-25
   Days after onset:26
Entered: 2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Accident, Anaemia, Brain oedema, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-04-25
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC Split Type:

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


VAERS ID: 151098 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Unknown  
Vaccinated:2000-03-05
Onset:2000-03-13
   Days after vaccination:8
Submitted: 2000-04-19
   Days after onset:36
Entered: 2000-04-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS - / 4 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Hypoxia, Infection, Muscular weakness, Paralysis
SMQs:, Rhabdomyolysis/myopathy (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-03-25
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy pending; viral antigens were neg, serum antibodies were satisfactory
CDC Split Type: MA20000120

Write-up: Pt was bitten by a stray dog. She received the rabies series of shots. Eight days after 4th dose pt was admitted to the hospital with a history of weakness of the right leg which progressed to left leg in 2 days, with episodes of seizures, weakness of upper limb, and respiratory paralysis. Pt had ascending paralysis and was put on a ventilator. Pt became comatose and died on March 25, 2000. It was determined that the rabies series was given incorrectly so the causality was attributed to rabies infection and not to the actual rabies vax.


VAERS ID: 151190 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:2000-04-06
Onset:2000-04-09
   Days after vaccination:3
Submitted: 2000-04-18
   Days after onset:9
Entered: 2000-05-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 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: 2000-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


VAERS ID: 151618 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2000-05-02
Onset:2000-05-04
   Days after vaccination:2
Submitted: 2000-05-04
   Days after onset:0
Entered: 2000-05-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


VAERS ID: 151619 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted: 2000-04-26
Entered: 2000-05-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (broad), 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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC Split Type:

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia


VAERS ID: 151620 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Louisiana  
Vaccinated:2000-04-17
Onset:2000-04-17
   Days after vaccination:0
Submitted: 2000-04-26
   Days after onset:9
Entered: 2000-05-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 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? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-17
   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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


VAERS ID: 151621 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Connecticut  
Vaccinated:2000-05-02
Onset:2000-05-03
   Days after vaccination:1
Submitted: 2000-05-03
   Days after onset:0
Entered: 2000-05-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome
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: 2000-05-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


VAERS ID: 151748 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2000-03-22
Onset:2000-04-17
   Days after vaccination:26
Submitted: 2000-04-20
   Days after onset:3
Entered: 2000-05-09
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 14775 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P09052 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-17
   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: hydrocortisone for dermatitis 3/22/2000
Current Illness: NONE
Preexisting Conditions: Possible milk protein allergy, dermatitis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS death within one months of IZ. Autopsy being performed.


VAERS ID: 151749 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2000-04-04
Onset:2000-04-13
   Days after vaccination:9
Submitted: 2000-04-19
   Days after onset:6
Entered: 2000-05-09
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 466024 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1192J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P1232 / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Feeding problems first 3 days of life only.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS 10 days post vax.


VAERS ID: 151799 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:1999-10-01
Onset:1999-10-05
   Days after vaccination:4
Submitted: 2000-04-28
   Days after onset:206
Entered: 2000-05-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Neoplasm, Quadriplegia, Respiratory arrest, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Non-haematological tumours of unspecified malignancy (narrow), Hypokalaemia (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:
Other Medications: Carboplatin, etoposide phosphate, cyclophosphamide.
Current Illness:
Preexisting Conditions: glioblastoma multiforme located in occipital region
Allergies:
Diagnostic Lab Data: probable cause of death-progression of tumor and respiratory failure
CDC Split Type: MPU2000002450

Write-up: This case concerns male who had had influenza vax 48 hours prior to chemotherapy. On day 3, after the carboplatin based tridrug chemotherapy with blood brain-barrier disruption (vertebral artery), he experienced respiratory arrest and rapid progression of quadriparesis. The pt remained quadriparetic and ventilator dependent and died 75 days after chemotherapy treatment. The authors conclude that the pathophysiology of the complication seen in the 7 pts is multi-factorial but may be related to vascular streaming and an atypical inflammatory toxic reaction to carboplatin or etoposide. The complication has not recurred during a 6 month period following modification of the protocol. Date of vax and onset not specified and therefore assumed to be associated with the 1999/1999 influenza season.


VAERS ID: 151867 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:2000-05-10
Onset:2000-05-11
   Days after vaccination:1
Submitted: 2000-05-11
   Days after onset:0
Entered: 2000-05-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


VAERS ID: 152001 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maine  
Vaccinated:2000-04-13
Onset:2000-04-18
   Days after vaccination:5
Submitted: 2000-05-10
   Days after onset:22
Entered: 2000-05-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Postmortem exam.
CDC Split Type:

Write-up: Two month old died of SIDS 5 days post vax (1st set).


VAERS ID: 152041 (history)  
Form: Version 1.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2000-04-25
Onset:2000-05-03
   Days after vaccination:8
Submitted: 2000-05-04
   Days after onset:1
Entered: 2000-05-18
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3066A4 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Coma, Convulsion, Pulmonary congestion, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-03
   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: Dilantin
Current Illness: NONE
Preexisting Conditions: hx of seizures
Allergies:
Diagnostic Lab Data: Medical examiner case (pending); preliminary cause of death is reported to be a seizure. Autopsy shows lung congestion and edema, final cause of death terminal seizure as a complication of her chronic seizure disorder.
CDC Split Type: OR200015

Write-up: Pt was found dead at home on 5/3/00. Pt was taking Dilantin on a regular basis. Pts mother died of aneurysm at age 40. Pt was otherwise healthy, but had a hx of seizures. Cause of death was determined to be a terminal seizure. Autopsy shows she was found unresponsive, lungs congested with edema.


VAERS ID: 152213 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arkansas  
Vaccinated:2000-03-30
Onset:2000-03-31
   Days after vaccination:1
Submitted: 2000-03-31
   Days after onset:0
Entered: 2000-05-22
   Days after submission:51
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 LL / SC

Administered by: Public       Purchased by: Other
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-31
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report pending
CDC Split Type: AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


VAERS ID: 152301 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:2000-04-17
Onset:2000-04-18
   Days after vaccination:1
Submitted: 2000-04-30
   Days after onset:12
Entered: 2000-05-24
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


VAERS ID: 152417 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:2000-05-22
Onset:2000-05-25
   Days after vaccination:3
Submitted: 2000-05-25
   Days after onset:0
Entered: 2000-05-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


VAERS ID: 152501 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:2000-01-14
Onset:2000-01-19
   Days after vaccination:5
Submitted: 2000-05-11
   Days after onset:112
Entered: 2000-05-30
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-01-19
   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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH0011

Write-up: SIDS


VAERS ID: 152502 (history)  
Form: Version 1.0  
Age: 0.08  
Sex: Male  
Location: Alabama  
Vaccinated:1999-12-06
Onset:1999-12-07
   Days after vaccination:1
Submitted: 1999-12-10
   Days after onset:3
Entered: 2000-05-30
   Days after submission:171
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC Split Type:

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


VAERS ID: 152566 (history)  
Form: Version 1.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2000-03-30
Onset:2000-04-12
   Days after vaccination:13
Submitted: 2000-05-24
   Days after onset:42
Entered: 2000-06-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Malignant lymphomas (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-05-25
   Days after onset: 43
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


VAERS ID: 152669 (history)  
Form: Version 1.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-06-01
Entered: 2000-06-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anaemia, Red blood cell count decreased, Thrombocytopenia
SMQs:, Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Pt was a high risk (nos).
Allergies:
Diagnostic Lab Data: The pt tested negative for antibodies (not specified). He was tested 3 days, post vax, and was found to have a low red blood cell count and a low thrombocyte count.
CDC Split Type: 20000161881

Write-up: The pt was considered a high risk (nos). According to the physician, he did not have cancer. The pt received Engerix-B vaccination (date, dose and series unspecified). It is unclear whether or not the pt developed antigenemia or aplastic anemia. According to the reporting physician, the pt needed a bone marrow transplant. Treatment of the adverse event was not specified. It was reported that "all other therapies failed" (nos). The pt died. All of this had occurred within ten days. The most recent information received on 5/24/2000, reports that the pt died (date and causality of death were not specified). Additional information has been requested.


VAERS ID: 152670 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-05-15
Onset:2000-05-25
   Days after vaccination:10
Submitted: 2000-05-30
   Days after onset:5
Entered: 2000-06-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1275J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Brain oedema, Liver disorder, Pallor, Pharyngitis, Pneumonia, Pulmonary congestion, Pyrexia, Rash macular, Respiratory failure, Rhinitis
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-28
   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: PPD - Lot number 0090P, ID, RA
Current Illness: NONE
Preexisting Conditions: febrile seizures, pneumococcal bacteremia
Allergies:
Diagnostic Lab Data: CBC-5500
CDC Split Type:

Write-up: on 5/25/00, pt had fever, cold symptoms for 2 days, runny nose, red pharynx, a few papules on face, WBC 5,500. 5/27 via phone call, pt was pale, had macular rash on nose and face, fever was 100.8. Pt was taken to ER on 5/28. DOA, (probably several hours). Autopsy states liver congestion, lung atelectasis, lung congestion, respiratory failure due to streptococcal (group B) pneumonia, ceberal edema,


VAERS ID: 152834 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Wisconsin  
Vaccinated:1994-05-12
Onset:1994-06-09
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Growth retardation, Mental retardation severity unspecified, Vision abnormal neonatal
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (narrow), Neonatal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-02
   Days after onset: 2154
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ?~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC Split Type:

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


VAERS ID: 153392 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:2000-06-01
Onset:2000-06-02
   Days after vaccination:1
Submitted: 2000-06-08
   Days after onset:6
Entered: 2000-06-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private       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: 2000-06-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PKU-nml
CDC Split Type:

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


VAERS ID: 153914 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2000-04-06
Onset:2000-05-13
   Days after vaccination:37
Submitted: 2000-05-30
   Days after onset:17
Entered: 2000-06-12
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV047 / 7+ LA / -

Administered by: Other       Purchased by: Other
Symptoms: Arteritis, Arthralgia, Death, Fatigue, Myocardial infarction, Oedema peripheral, Polyarteritis nodosa, Vasculitis
SMQs:, Cardiac failure (broad), Angioedema (broad), Interstitial lung disease (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Received injection in 2 stages. On May 13, 2000 hands, forearms swollen, joints ached, shoulder sore, very tired. Used Benadryl also was given Cicsorex for pain. That did not help. Was given Advil 800 mg. As of 6/4/2000 pt still has fatigue, swelling and pain.


VAERS ID: 154522 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2000-05-10
Onset:2000-05-13
   Days after vaccination:3
Submitted: 2000-06-08
   Days after onset:26
Entered: 2000-06-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


VAERS ID: 155408 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:2000-05-24
Onset:2000-05-24
   Days after vaccination:0
Submitted: 2000-06-21
   Days after onset:28
Entered: 2000-06-26
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 922A2 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1736J / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 440146 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P1380 / 1 LA / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471213 / 1 LL / IM

Administered by: Other       Purchased by: Private
Symptoms: Ascites, Blood bilirubin increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (narrow), Biliary system related investigations, signs and symptoms (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-08
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Neonatal hepatitis
Preexisting Conditions: Biliary atresia, neonatal hepatitis
Allergies:
Diagnostic Lab Data: Routine labs done on 5/24/2000, bilirubin was elevated to 34.1mg/dl.
CDC Split Type: 7513419

Write-up: A 4 month old female received her 1st vaccines and was seen in the clinic on 5/24/2000. That evening, she was hospitalized. On 5/25/2000, inpatient laboratory tests were performed and the pt underwent a Kasai procedure. Post surgery, she developed massive ascites. The pt was transferred to a tertiary care facility on 5/27/2000 and a liver transplant was performed. She developed post surgical complications and expired on 6/8/2000. The reporter indicated that the pt''s death was "clearly unrelated to vaccination". Cause of death was not provided.


VAERS ID: 155423 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Michigan  
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted: 2000-06-20
Entered: 2000-06-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Coma, Pneumonitis, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (narrow), Neonatal disorders (narrow), Hypersensitivity (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: 2000-06-18
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 pending
CDC Split Type:

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


VAERS ID: 155590 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New Hampshire  
Vaccinated:2000-01-03
Onset:2000-02-15
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 2 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Pulmonary congestion, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Neonatal disorders (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


VAERS ID: 155775 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: New Mexico  
Vaccinated:2000-06-09
Onset:2000-06-17
   Days after vaccination:8
Submitted: 2000-06-20
   Days after onset:3
Entered: 2000-06-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC Split Type:

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


VAERS ID: 155888 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:1999-11-29
Onset:1999-12-03
   Days after vaccination:4
Submitted: 2000-06-29
   Days after onset:208
Entered: 2000-07-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Dyspnoea, Fatigue, Hypoxia, Nausea, Pneumonitis, Pyrexia, Rheumatoid factor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-01-06
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 31 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Methotrexate tablet, amantadine, calcium
Current Illness: UNK
Preexisting Conditions: arthritis, parkinsonism, blepharitis, drug hypersensitivity
Allergies:
Diagnostic Lab Data: open lung biopsy-acute interstitial pneumonitis. A bronchoscopy examination on 12/10/99 was unremarkabl; however, microscopic analysis of pooled bronchoalveolar levage revealed acute and chronic inflammation with rare atypical squamous and bronchial epithelial cells. Bronchial lavage cultures were negative. A chest x-ray on 12/13/99, revealed progressive RUL infiltrate with no improvement in severe bilateral lparenchymal disease compared to 12/12/99. A chest x-ray on 12/15/99 revealed significant improvement since 12/14. Lab test results in December 1999 included: rheumatoid factor, positive; ANA negaitve; and ESR 106. Based on these lab results and the fact that the pt remained afebrile, the neurologist suggested htat an autoimmune process should be considered. ON 12/10/99, C-ANCA and P-ANCA were both negtive. The pt''s WBC count rose steadily from 14,400 cells/mm^3 on 12/10/99 to 40,700 cells/mm^3 on 1/6/00. . Findings during a lung biopsy on 12/21/99 were a severely diffuse process with ver friable weak lung prenchyma incapable of holding either stapling devices and/or sutures. Cultures of lung tissue were negative for bacteria, virus and fungi. Blood cultures on 12/20/99 were positive for coagulase-negative Staphylococci and sputum cultures were positive for presumptive Candida albicans. A sputum culture on 1/4/00 was positive for P. seruginosa. A PPD performed during the hospital stay was negative. On 12/23/99, a chest x-ray revealed a small apical pneumothorax and development of what appeared tobe pneumopericardium and neumomediastinum since 12/22/99, with persistent bilateral pulmonary densities consistent with severe pulmonary edema. Hematology results on 12/7/99,included WBC and absolute neutrophil count which rose from 7.3 x 10^3 and 6.12 x 10^3 respectively, to 12.4 x 10^3 and 10.68 x 10^3 on 12/9/99. Seurm osmolarity was 253 and potassium was 2.4 on 12/7/99. Lab test results on 12/8/99 were creatinine 0.4; sodium 125; and chloride 94. Blood, pleural fluid, and urine cultures were negative. A chet x-ray on 12/7/99, revealed a dense upper lobe consolidation (lung infiltration NOS) with focal areas at the right base and mid-lung. A chest x-ray on 12/9/99 revealed worsening bialteral air-space consistent with pneumonia, pulmonary hemorrhage, or atypical pulmonary edema. A CT scan of the chest showed a predominatly alveolar process with marked areas of consolitation involving the lungs bilaterally; a moderately large right-sided pleural effusion; right lobe volume loss; and atherosclerotic aortic disease. An abdominal x-ray on 12/8/99 was suggestive of ileus.
CDC Split Type: HQ7946728JUN2000

Write-up: Pt received flu vax on 11/29/99. The pt was receiving weekly methotrexate to treat rheumatoid arthritis at the time of immunization. She became ill on 12/3/99. On 12/7/99, she was seen by her physician and hospitalized in the ICU. She required mechanical ventilator on 12/12/99. The pt died on 1/6/00. The treating physicians reportedly attributed this event to the methotrexate therapy. The husband attributed this event to an interaction between the flu vax and methotrexate. On Follow-up pt had a history of Parkinsonism. Medical records were recieved on 7/12/00. The pt had increasing shortness of breath and fatigue for months prior to hospitalization. On 12/7/99, she was hospitalized because of fatigue, shortness of breath, nausea, and possible low-grade fever. Medical history included allergies to metoclopramide, ibuprofen, and salsalate. During hospitalization, her rheumatoid factor was positive; ANA titer was negative, ESR was 106mm/hr. Chest x-ray revealed "severe bilateral parenchymal disease since December 12, 1999." Follow up info was received from a medical center on 8/17/00, 9/28, and 10/25/00.The pt is a non-smoker and abstains from alcohohl. She has a past hisotry of bilateral silicone breast implant with subsequent removal, partial vaginal hysterectomy, tubal ligation. She also had problems with occasional choking and gasping while eating and drinking, though no recent episodes of aspiration were reported. the pt''s medical history includes a recent treatment with Mirapex and requip, which were discontinued due to "intolerance." Therapy with Methotrexate 15mg weekly for rheumatoid arthritis began in 1997 and ceased after 12/5/99. The pt received her 1999-2000 formula influenza virus vaccine on 11/29/99, approximately 14 hrs afte her methotrexate dose. A chest x-ray revealed bialteral infiltrates with the greatest concentration int he left perihilar and righ tupper lobe region. The differential diagnosis at this time included congestive heart failure, aspiration, connective tissue disease, drug reaction, atypical community acquired pneumonia, and other atypical infections. Immunosuppresive therapy, including methotrexate, was withdrawn. A bronchoscopy examination on 12/10/99 was unremarkable; however, microscopic analysis of pooled bronchoalveolar levage revealed acute and chronic inflammation with rare atypical squamous and bronchial epithelial cells. Bronchial lavage cultures were negative. The pt was inturbated and ventilated on 12/12/99. A chest x-ray on 12/13/99, revealed progressive RUL infiltrate with no improvement in severe bilateral lparenchymal disease compared to 12/12/99. The pt was also treated with piperacillin/tazobactam and imipenem/cilastatin. Additional therapy included furosemide, propofol and lorazempam. Physical examination on 12/13/99 revealed lungs iwth bialteral rhonchi and rales. A chest x-ray on 12/15/99 revealed significant improvement since 12/14. Lab test results in December 1999 included: rheumatoid factor, positive; ANA negaitve; and ESR 106. Based on these lab results and the fact that the pt remained afebrile, the neurologist suggested htat an autoimmune process should be considered. ON 12/10/99, C-ANCA and P-ANCA were both negtive. The pt''s WBC count rose steadily from 14,400 cells/mm^3 on 12/10/99 to 40,700 cells/mm^3 on 1/6/00. Amantadine was discontinued due to the pt''s fatigue. Findings during a lung biopsy on 12/21/99 were a severely diffuse process with ver friable weak lung prenchyma incapable of holding either stapling devices and/or sutures. The lung was extremely abnormal and did not appear to be ventilating or aerating well. Microscopic analysis revealed rapidly progressive diffuse alveolar damage considdtent with acute interstitial pneumonitis of unknown etiology. The abnormalities were temporally uniform and reflected an episode of massive acute lung injury occurring at a single point in time. The pt continued to have a persisitent broncho-alveolar fistula following thoracic surgery. Cultures of lung tissue were negative for bacteria, virus and fungi. Blood cultures on 12/20/99 were positive for coagulase-negative Staphylococci and sputum cultures were positive for presumptive Candida albicans. A sputum culture on 1/4/00 was positive for P. seruginosa. A PPD performed during the hospital stay was negative. On 12/23/99, a chest x-ray revealed a small apical pneumothorax and development of what appeared tobe pneumopericardium and neumomediastinum since 12/22/99, with persistent bilateral pulmonary densities consistent with severe pulmonary edema. The impression was that ARDS was a consideration. Corticosteroid therapy with subsequently initiated. The consumer reported that the pt had lost "50% of her then reduced lung capacity" and she required an increase in her oxygen from "60% to 100% and requiring paralyzing drugs." A chest x-ray on 1/6/00 revealed a reduced right apical pneumothorax with dense infiltrates bilaterally. There appeared to be increase in air within the right basilar pleural space compared to prior film. Subcutaneous emphysema is increased in the right axillary region. She died on 1/6/00, from respiratory failure secondary to acute interstitial penumonitis. The consumer reported that the event was a result of a compromised immune system, which the consumer felt was exacerbated by the influenza virus vaccine. The pulmonologist confirmed the pneumonitis, but due to its uncertain etiology, could not confirm that the pt had pneumonia. Further medical records recieved on 9/28/00, provided additional medical history of bone mass decreased (osteopenia), gastro-oesophageal reflux disease; los of balance resulting in falls, and headaches NOS. Medications included /Relafen, Sinemet. On 12/7/99, the pt''s flu-like illness included scratchy, then sore throat, cough and chills. Hematology results on 12/7/99,included WBC and absolute neutrophil count which rose from 7.3 x 10^3 and 6.12 x 10^3 respectively, to 12.4 x 10^3 and 10.68 x 10^3 on 12/9/99. Seurm osmolarity was 253 and potassium was 2.4 on 12/7/99. Lab test results on 12/8/99 were creatinine 0.4; sodium 125; and chloride 94. Blood, pleural fluid, and urine cultures were negative. A chet x-ray on 12/7/99, revealed a dense upper lobe consolidation (lung infiltration NOS) with focal areas at the right base and mid-lung. A chest x-ray on 12/9/99 revealed worsening bialteral air-space consistent with pneumonia, pulmonary hemorrhage, or atypical pulmonary edema. A CT scan of the chest showed a predominatly alveolar process with marked areas of consolitation involving the lungs bilaterally; a moderately large right-sided pleural effusion; right lobe volume loss; and atherosclerotic aortic disease. An abdominal x-ray on 12/8/99 was suggestive of ileus. Her diagnosis at this time was RUL infiltrate and pleural effision, thought to be secondary to aspiration. She also had ileus and hyponatremia secondary to SIADH, both considered secondary to the pulmonary proces. The pt also had increased lower extremity weakness. (Reference methotrexate case number HQ7226113JUN2000).


VAERS ID: 156329 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-05-31
Onset:2000-06-01
   Days after vaccination:1
Submitted: 2000-06-30
   Days after onset:29
Entered: 2000-07-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0056FA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0053K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0997 / 1 RL / IM

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Coma, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Salivary hypersecretion, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-01
   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: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autopsy-pending (SIDS)
CDC Split Type: MS00026

Write-up: Post vax, on 6/1/2000 AM, the mother stated that infant was fine when he was put in bed with her and then when she tried to awaken the child, he was lying on his stomach with mucus from mouth and not breathing. Autopsy shows cause of death as sudden infant death, pulmonary congestion and edema, splenic congestion, renal congestion, unresponsive.


VAERS ID: 156370 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:2000-07-06
Onset:2000-07-07
   Days after vaccination:1
Submitted: 2000-07-11
   Days after onset:4
Entered: 2000-07-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 2 RL / -

Administered by: Private       Purchased by: Other
Symptoms: Acidosis, Anaemia, Bacterial infection, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-07-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC Split Type:

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.


VAERS ID: 156861 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Alabama  
Vaccinated:2000-06-06
Onset:2000-06-09
   Days after vaccination:3
Submitted: 2000-06-29
   Days after onset:20
Entered: 2000-07-17
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC Split Type: AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


VAERS ID: 133897 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Male  
Location: Florida  
Vaccinated:2000-02-10
Onset:2000-02-10
   Days after vaccination:0
Submitted: 2000-02-11
   Days after onset:1
Entered: 2000-07-20
   Days after submission:159
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-10
   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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


VAERS ID: 157668 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-12-10
Entered: 2000-07-20
   Days after submission:222
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Coma, Cyanosis, Dyspnoea, Hypotonia, Nystagmus, Pyrexia, Stridor, Unevaluable event, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ7644307DEC1999

Write-up: Physician reported that a pt died following the receipt of RotaShield. The baby arrived unresponsive, blue, difficulty in breathing, hypotonic, had vertical nystagmus, had fever, stridor, wheezing, looked cyanotic.


VAERS ID: 157956 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: California  
Vaccinated:2000-07-12
Onset:2000-07-14
   Days after vaccination:2
Submitted: 2000-07-14
   Days after onset:0
Entered: 2000-07-26
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0554K / 1 LL / IM

Administered by: Other       Purchased by: Public
Symptoms: Cardiac arrest, Cerebral palsy, Respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-07-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: Cerebral Palsy, Broncho-pulmonary dysplasia
Preexisting Conditions: 27 week gestation, cerebral palsy
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: The child was found by the mother in AM, not breathing and without heart rate. Cause of death stated as complications of cerebral palsy. 07/26/2000 12:00 call to MD nurse who read baby''s chart to me. She said she will fax mediccal records to us today. received at 13:00. 07/26/2000 call to coroner''s office. Esitmate of what preliminary COD might be "complication of cerebral palsy". Letter of request for final autopsy report sent.


VAERS ID: 158090 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted: 2000-07-25
Entered: 2000-07-28
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC Split Type:

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


VAERS ID: 158477 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Mexico  
Vaccinated:2000-07-31
Onset:2000-08-01
   Days after vaccination:1
Submitted: 2000-08-04
   Days after onset:3
Entered: 2000-08-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0290K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Coma, Conjunctivitis, Nasal congestion, Pulmonary congestion, Seborrhoeic dermatitis, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conjunctival disorders (narrow), Ocular infections (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-08-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death from SIDS. Autopsy shows congestion of thymus, lungs, adrenals and spleen. Also shows seborrhic dermatitis, conjunctivitis, unresponsive.


VAERS ID: 158749 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Missouri  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-08-07
Entered: 2000-08-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Infection
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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00072609

Write-up: Subsequently post vax, the pt developed hib disease, sought unspecified medical attention and died. This was due to haemophilus b recombinant vax causing decreased antibody levels than haemophilus b conjugate vax. A follow up report received 9/25/2000 adds: On 8/15/2000 called reporter - she has no further info except that vaccine was Hib titer, not Comvax, and that pt was in Tx. She will try to contact drug rep who passed info to her to get more info. Letter has been sent to MD concerning this report - As soon as she gets any feedback, she will pass it on to us. 9/25/2000: Pt did not die! Change to serious status.


VAERS ID: 158751 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: Wisconsin  
Vaccinated:2000-07-27
Onset:2000-07-28
   Days after vaccination:1
Submitted: 2000-07-31
   Days after onset:3
Entered: 2000-08-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 2 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardio-respiratory 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 (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.


VAERS ID: 159003 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Unknown  
Vaccinated:2000-08-04
Onset:2000-08-05
   Days after vaccination:1
Submitted: 2000-08-08
   Days after onset:3
Entered: 2000-08-21
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC Split Type:

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


VAERS ID: 159082 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-08-17
Entered: 2000-08-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: WAES00081242

Write-up: Information has been received from a consumer concerning "someone in her neighborhood" who was vaccinated with varicella vaccine, and died the day of the vaccine. Follow up information from a registered nurse from the consumer''s MD office, reported that she had heard that a child of approximately 5 years of age had died in town after a live virus vaccine, but the child also had a viral illness with a high fever. The cause of death was not reported. It was reported that another child had adverse events following exposure to varicella virus vaccine. Additional information has been requested.


VAERS ID: 159083 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: New Hampshire  
Vaccinated:2000-08-15
Onset:2000-08-15
   Days after vaccination:0
Submitted: 2000-08-16
   Days after onset:1
Entered: 2000-08-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Blood disorder, Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting
SMQs:, Haemolytic disorders (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-08-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC Split Type:

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


VAERS ID: 159916 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Texas  
Vaccinated:2000-09-11
Onset:2000-09-14
   Days after vaccination:3
Submitted: 2000-09-14
   Days after onset:0
Entered: 2000-09-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


VAERS ID: 159963 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-09-13
Onset:2000-09-20
   Days after vaccination:7
Submitted: 2000-09-20
   Days after onset:0
Entered: 2000-09-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0429K / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473334 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-20
   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: Tylenol
Current Illness:
Preexisting Conditions: Initial low blood sugar
Allergies:
Diagnostic Lab Data: Autopsy pending; blood cultures-neg
CDC Split Type:

Write-up: The pt was found pulseless and apneic in crib at 08:00 on 9/20/00.


VAERS ID: 159131 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: Texas  
Vaccinated:2000-08-08
Onset:2000-08-10
   Days after vaccination:2
Submitted: 2000-09-24
   Days after onset:45
Entered: 2000-09-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0712K / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471222 / 2 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Status epilepticus
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-24
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Connaught/C0046AA/LFA/0 previously
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: complete work up
CDC Split Type:

Write-up: Status epilepticus-simple partial (motor). Left body started about 48 hours after immunization.


VAERS ID: 160203 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: Illinois  
Vaccinated:2000-08-31
Onset:2000-09-01
   Days after vaccination:1
Submitted: 2000-09-01
   Days after onset:0
Entered: 2000-09-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1489 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt was brought into the ER in full cardio respiratory arrest. Autopsy states cause of death as hypernatremia.


VAERS ID: 160354 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2000-03-14
Onset:0000-00-00
Submitted: 2000-10-02
Entered: 2000-10-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV031 / UNK - / SC

Administered by: Military       Purchased by: Unknown
Symptoms: Aplastic anaemia, Fungal infection, Respiratory disorder
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Acute central respiratory depression (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-14
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: The pt experienced A-Plastic anemia, invasive aspergillosis.


VAERS ID: 160417 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kentucky  
Vaccinated:2000-09-22
Onset:2000-09-24
   Days after vaccination:2
Submitted: 2000-10-03
   Days after onset:9
Entered: 2000-10-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


VAERS ID: 160423 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Male  
Location: Alaska  
Vaccinated:2000-02-17
Onset:2000-03-08
   Days after vaccination:20
Submitted: 2000-03-17
   Days after onset:9
Entered: 2000-10-11
   Days after submission:207
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


VAERS ID: 160612 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1997-11-11
Onset:1997-11-12
   Days after vaccination:1
Submitted: 2000-10-10
   Days after onset:1062
Entered: 2000-10-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, High-pitched crying, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Platelet count increased, Pneumonia, Pyrexia, Respiratory arrest
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-11-29
   Days after onset: 17
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC Split Type:

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


VAERS ID: 160801 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Male  
Location: Illinois  
Vaccinated:2000-10-10
Onset:2000-10-15
   Days after vaccination:5
Submitted: 2000-10-20
   Days after onset:5
Entered: 2000-10-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC Split Type: U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


VAERS ID: 160872 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2000-10-09
Onset:2000-10-09
   Days after vaccination:0
Submitted: 2000-10-18
   Days after onset:9
Entered: 2000-10-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring
SMQs:, Anaphylactic reaction (broad), Disorders of sinus node function (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


VAERS ID: 160876 (history)  
Form: Version 1.0  
Age: 98.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1999-12-01
Onset:2000-04-01
   Days after vaccination:122
Submitted: 2000-10-19
   Days after onset:200
Entered: 2000-10-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bone disorder, Cough, Dysphagia, Infection, Nasopharyngitis, Pneumonia aspiration, Pyrexia, Rhinorrhoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-08-22
   Days after onset: 142
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cefadroxil, Aricept, Levaquin
Current Illness:
Preexisting Conditions: nonspecific allergy; pneumonia
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00100866

Write-up: In April 2000, the pt developed a cold. Additionally, it was noted that she kept a fever, had difficulty swallowing, difficulty drinking fluids, runny nose, continuous vomiting and coughing of mucous. It was reported that three months post vax, the pt became worse and her doctor prescribed her cefadroxil. She felt better and her cold symptoms disappeared for approximately one month. It was noted that subsequently her condition turned for the worse and that on 4/1/00 the pt was taken to the hospital because of feet were infected. The pt reportedly had no skin on her feet and had an infection of the bones. Additionally, on 8/1/00 the pt was dx with pneumonia. On 8/22/00, the pt died. The cause of death was aspiration pneumonia. The follow up received on 11/14/00 states that "they suctioned from her throat, a whole bottle of milky white fluid." Follow up info from a consumer (son of pt) reported that the primary care physiican reviewed his mother''s records and there was no record of pneumococcal vaccine 23 polyvalent for the pt. He also felt that his mother''s experience were disabling, life threatening and had prolonged her hospitalization. Follow up info from the physician indicated that the pt entered his practice in September 1998 and received the influenza vaccine in fall of 1999. He was emphatic that the pt did not receive pneumococcal vaccine 23 polyvalent at any time from his practice but acknowledged that she could have received the product elsewhere. He also noted that the pt''s son was advised to transfer his mother to a nursing home when she became confined to bed, but that the son indicateed that he ''could and would'' provide proper care to his mother. Additionally, the physician stated that the pt developed decubitus ulcers which subsequently became infected and then she develoepd osteomyelitis. She was then admitted to a nursing home for 6 weeks of parenteral antibiotic treatment. The pt had a DNR request authorizing IV antibiotics and other supportive treatment but nothing heroic. It was noted that the pt developed terminal pneumonia during this period. The physician also stated that he was not aware of any autopsy report for the pt. Follow up info from the pt''s son indicated that in November 1998 the pt had pneumonia and because of this should have never received the vaccine. No further info is available. A 15-day follow up report received 6/27/2002 adds: Follow-up info was received from the pt''s son who stated that his mother died in August after she was given the (pneumococcal vaccine 23 polyvalent) shot. He reported that the cause of death was a very bad foot infection caused by pressure ulcers. No further info is available. Follow up on 12/27/2002: "Follow up information from a consuer (son of patient) reported that the PCP reviewed his mother''s records and there was no record of pneumococcal vaccine 23 polyvalent for the patient. He also felt that his mother''s experiences were disabling, life threatening and had prolonged her hospitalization. Follow up information from the physician indicated that the patient entered his practice in 09/1998 and received the influenza vaccine in fall of 1999. He was emphatic that the patient did not receive pneumococcal vaccine 23 polyvalent at any time from his practice but acknowledged that she could have received the product elsewhere. He also noted that the patient''s son was advised to transfer his mother to a nursing home when she became confined to bed, but that the son indicated that he "could and would" provide proper care to his mother. Additionally, the physician stated that the patient developed decubitus ulcers which subsequently became infected and then she developed osteomyelitis. She was then admitted to a nursing home for 6 weeks of parenteral antibiotic treatment. The patient had a DNA request authorizing IV antibiotics and other supportive treatment but nothing heroic. It was noted that the patient developed terminal pneumonia during this period. The physician also stated that he was not aware of any autopsy report for the patient. Follow up information from the patient''s son indicated that in November of 1998 the patient had pneumonia and because of this hsould have never received the vaccine. Follow up information was received from the patient''s son who stated that his mother died in August after she was given the (pneumococcal vaccine 23 polyvalent) shot. He reported that the cause of death was a very bad foot infection caused by pressure ulcers. This is an amended report. The primary reporter now reads physician instead of consumer. No further information is available. This is a corrected report as amended."


VAERS ID: 160877 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:2000-10-05
Onset:2000-10-06
   Days after vaccination:1
Submitted: 2000-10-18
   Days after onset:12
Entered: 2000-10-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Bacterial infection, Coma, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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: 2000-10-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC Split Type:

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


VAERS ID: 161041 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Ohio  
Vaccinated:2000-10-19
Onset:2000-10-20
   Days after vaccination:1
Submitted: 2000-10-23
   Days after onset:3
Entered: 2000-10-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


VAERS ID: 161098 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:2000-10-25
Onset:2000-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2000-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1945J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R1433 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Asphyxia, Cardiac arrest, Coma, Pulmonary congestion, Renal disorder, Suffocation feeling
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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), Hostility/aggression (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol for fever
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray in ER-no cardiopulmonary process
CDC Split Type:

Write-up: Pt received vaccines on 10/25/00 and on 10/26/00, infant asleep with 16 year old sibling. Mother found arm of sibling across baby''s face and baby was not breathing. CPR was administered and intubation to no avail. Autopsy shows found unresponsive, congestion of lungs, kidneys congested. Final cause of death stated as suffocation by mechanical asphyxia.


VAERS ID: 161164 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:2000-09-22
Onset:2000-09-26
   Days after vaccination:4
Submitted: 2000-10-18
   Days after onset:22
Entered: 2000-11-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


VAERS ID: 161215 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Indiana  
Vaccinated:2000-07-24
Onset:2000-07-25
   Days after vaccination:1
Submitted: 2000-10-27
   Days after onset:94
Entered: 2000-11-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


VAERS ID: 161299 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted: 2000-11-02
Entered: 2000-11-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC Split Type:

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


VAERS ID: 161415 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:2000-08-22
Onset:2000-09-27
   Days after vaccination:36
Submitted: 2000-10-07
   Days after onset:10
Entered: 2000-11-07
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC Split Type: OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


VAERS ID: 161416 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Illinois  
Vaccinated:2000-10-10
Onset:2000-10-15
   Days after vaccination:5
Submitted: 2000-11-02
   Days after onset:18
Entered: 2000-11-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Apnoea, Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC Split Type: U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


VAERS ID: 161439 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:2000-07-26
Onset:2000-07-29
   Days after vaccination:3
Submitted: 2000-08-03
   Days after onset:5
Entered: 2000-11-07
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1738J / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 582953A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R04442 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-07-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-pending
CDC Split Type: OR200036

Write-up: It was reported to a health department that a baby had died. An Autopsy is being done. The cause of death is probable SIDS. Further studies pending.


VAERS ID: 161587 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Missouri  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-11-06
Entered: 2000-11-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00082987

Write-up: Post vax, the pt died from Hib disease. Additional information from the reporting physician confirmed that a representative from another company told him that she had heard of a Hib disease death in a child after receiving Hib vax. The physician could not and would not provide further details.


VAERS ID: 161719 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:1999-03-26
Submitted: 2000-11-03
   Days after onset:588
Entered: 2000-11-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea, Gastroenteritis, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The child was reported to be sick with a virus and diarrhea for a couple of weeks. The pt was taken to the ER by EMS after mother found the child unresponsive. The baby was pronounced dead on arrival at the Hospital. The cause of death was dehydration, vomiting, diarrhea, viral gastroenteritis.


VAERS ID: 161720 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Jersey  
Vaccinated:2000-05-11
Onset:2000-05-13
   Days after vaccination:2
Submitted: 2000-11-02
   Days after onset:173
Entered: 2000-11-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 470525 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0905 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Influenza like illness, Irritability, Rhinorrhoea, Screaming, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-03
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 5/11/00, pt was given 3 shots; IPV, DTP, and HIB. Her problems started almost 2 days later. She was not the same little girl I know. She was very cranky and would cry for hours (non-stop) like she was in pain, then she started to get flu-like symptoms (runny nose and chest congestion) to where she couldn''t breathe. I called the pediatrician and he told me she was fine and it was because the weather was changing. She was like that for a while. I called again and he told me I was getting upset over nothing and that she was ok, because she had no fever. So I took his word for it and I even told him I think she is having a reaction to the shots and he said no, it''s the weather. That Friday night, I laid her down to sleep for the night and she never woke up. They told me it was SIDS and for some reason I just can''t believe that. She was fine until they gave her them shots.


VAERS ID: 161756 (history)  
Form: Version 1.0  
Age: 0.75  
Sex: Male  
Location: Kentucky  
Vaccinated:2000-07-03
Onset:2000-07-19
   Days after vaccination:16
Submitted: 2000-11-05
   Days after onset:109
Entered: 2000-11-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 1 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Bacterial infection, Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-07-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC Split Type:

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


VAERS ID: 161757 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Nevada  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-11-07
Entered: 2000-11-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


VAERS ID: 161790 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2000-11-03
Onset:2000-11-08
   Days after vaccination:5
Submitted: 2000-11-10
   Days after onset:2
Entered: 2000-11-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2001-02-07
   Days after onset: 91
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.


VAERS ID: 161811 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Louisiana  
Vaccinated:2000-09-08
Onset:2000-09-16
   Days after vaccination:8
Submitted: 2000-11-06
   Days after onset:51
Entered: 2000-11-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0289K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiac disorder, Nasal congestion, Pulmonary oedema, Sudden infant death syndrome, Upper respiratory tract infection
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy; blood cultures-all results neg-SIDS
CDC Split Type:

Write-up: Post vax, the pt developed URI symptoms. Was seen in office on 9/14/00 with nasal congestion. She had a cardiac event on 9/16/00 and died. Autopsy revealed SIDS. Autopsy shows pulmonary edema.


VAERS ID: 161853 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-10-03
Onset:2000-10-09
   Days after vaccination:6
Submitted: 2000-11-06
   Days after onset:28
Entered: 2000-11-15
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC Split Type: MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


VAERS ID: 162016 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Ohio  
Vaccinated:2000-11-02
Onset:2000-11-06
   Days after vaccination:4
Submitted: 2000-11-08
   Days after onset:2
Entered: 2000-11-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 468397 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P1412 / 2 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cyanosis, Encephalopathy, Hypotension, Hypoxia, Laboratory test abnormal, Pyrexia, Tachycardia, Tonic clonic movements
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Respiratory compromise~Pneumo (Prevnar)~1~0.00~In Patient
Other Medications: Diuril, Lasix, NaC1 supplements, Zantac, Reglan, Fe therapy, Augmentin, Synthroid, albuterol, Atrovent, Aldactone, Intal, Synagis/Med-Immune/IM/0 previously
Current Illness: pneumonia
Preexisting Conditions: Premature at 28 weeks gestation, delivered in ambulance and given blow-by O2 en route. He was treated for narcotic withdrawal, apneas, bradycardias, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, hyperbilirubinemia, anemia, GERD and presumed sepsis; profound hypothyroidism
Allergies:
Diagnostic Lab Data: CBC-5.5 with 86 polys, 6 lymphs, 7 monos, 1 eos; UA-nml; CBG-7.28/PC02 110/Bicarb 49
CDC Split Type:

Write-up: Encephalopathy within 7days of DTAP. (See attached). Early AM of 11/6, he spiked a fever of 38.4C. He was noted to be bradycardic during the blood draw but recovered immediately. He was also noted to have apnea lasting up to 20 seconds, associated with desats down to high 80''s while on O2. At 13:30, RN responded to apnea alarm. He was not breathing and sats were down to 50''s. He was stimulated and MD was called. He continued to be apneic, by this time sats down to 30''s with dusky color. HR remained over 140''s. Decision was made to send him to PICU. He had IV placed and during which time he was given CPAP via bagging, 0.4mg of MSO4 given, intubation was 1st attempted by resident MD with attending supervision. After placement of ETT, we were unable to hear good breath sounds and pt had poor color, so tube was pulled, NG place, pt continued to be bagged back to 100%. No epinephrine was given (HR recovered by the time epi was drawn up). After this report was prepared, I was called back into the pt''s room, because he became tonic with mouth movements. Was given valium and pt''s extremities relaxed. At about the same time, his BP was found to be low, MAPs 30-40. NS bolus of 20/kg given. On 60-day followup: pt was transferred to ICU where he got slightly better, then worse again. He died 12/2000. The pt was medically fragile and because his decompensation occurred after DTAP I reported it. Believes his decompensation is multifactorial and not related to vaccines alone.


VAERS ID: 162101 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Iowa  
Vaccinated:1999-10-14
Onset:1999-10-29
   Days after vaccination:15
Submitted: 2000-11-13
   Days after onset:381
Entered: 2000-11-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Haemoptysis
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-12-23
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC Split Type:

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


VAERS ID: 162102 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:2000-11-07
Onset:2000-11-07
   Days after vaccination:0
Submitted: 2000-11-15
   Days after onset:8
Entered: 2000-11-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-09
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


VAERS ID: 162446 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Maryland  
Vaccinated:2000-11-01
Onset:2000-11-03
   Days after vaccination:2
Submitted: 2000-11-17
   Days after onset:14
Entered: 2000-11-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 1 - / IM

Administered by: Public       Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conduction defects (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-05
   Days after onset: 2
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


VAERS ID: 162552 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nebraska  
Vaccinated:2000-10-25
Onset:2000-10-26
   Days after vaccination:1
Submitted: 2000-11-20
   Days after onset:25
Entered: 2000-11-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC Split Type:

Write-up: Death was caused by SIDS.


VAERS ID: 162585 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2000-10-23
Onset:2000-10-23
   Days after vaccination:0
Submitted: 2000-11-17
   Days after onset:25
Entered: 2000-11-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other       Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC Split Type:

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


VAERS ID: 162587 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Carolina  
Vaccinated:2000-11-09
Onset:2000-11-10
   Days after vaccination:1
Submitted: 2000-11-22
   Days after onset:12
Entered: 2000-11-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC Split Type:

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


VAERS ID: 162588 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:1996-07-09
Onset:1996-10-01
   Days after vaccination:84
Submitted: 2000-11-14
   Days after onset:1505
Entered: 2000-11-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Drug interaction, Injury
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-03-26
   Days after onset: 176
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PPD/4 previously, Aldactone, methadone, vitamin K, spironolactone, penicillin V
Current Illness: leg abscess, hepatitis
Preexisting Conditions: Allergies to ampicillin/penicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: January through February of 1997, in jail. He almost died from adverse reactions to medication given to him by doctors. He was falsely arrested for not completing program/he was injured and no one would help him. I seen when they overdosed him with drugs.


VAERS ID: 162631 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:2000-11-14
Onset:2000-11-15
   Days after vaccination:1
Submitted: 2000-11-20
   Days after onset:5
Entered: 2000-11-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 1 RL / 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: 2000-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC Split Type:

Write-up: The pt died from SIDS within 24 hours post vax.


VAERS ID: 162748 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:2000-09-18
Onset:2000-09-20
   Days after vaccination:2
Submitted: 2000-11-20
   Days after onset:61
Entered: 2000-11-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Pneumonia, Unevaluable event
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: 2000-09-20
   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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


VAERS ID: 162990 (history)  
Form: Version 1.0  
Age: 0.08  
Sex: Female  
Location: North Carolina  
Vaccinated:2000-09-29
Onset:2000-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2000-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5151A2 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NC00092

Write-up: NONE Autopsy shows infant had upper respiratory infection week before death, found not breathing. Cause of death given as sudden infant death syndrome.


VAERS ID: 163135 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Tennessee  
Vaccinated:2000-09-05
Onset:2000-09-06
   Days after vaccination:1
Submitted: 2000-11-05
   Days after onset:60
Entered: 2000-12-06
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

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: 2000-09-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


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