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VAERS ID: 28528 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-02-18
Onset:1991-02-18
   Days after vaccination:0
Submitted: 1991-02-19
   Days after onset:1
Entered: 1991-03-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


VAERS ID: 28753 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:1990-11-23
Onset:1990-11-24
   Days after vaccination:1
Submitted: 1990-11-30
   Days after onset:6
Entered: 1991-03-04
   Days after submission:94
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other       Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (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: 1990-11-29
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


VAERS ID: 28826 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-16
Onset:1991-02-09
   Days after vaccination:24
Submitted: 1991-02-15
   Days after onset:6
Entered: 1991-03-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR913

Write-up: SIDS.


VAERS ID: 28827 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Oregon  
Vaccinated:1991-02-07
Onset:1991-02-09
   Days after vaccination:2
Submitted: 1991-02-21
   Days after onset:12
Entered: 1991-03-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report documented SIDS as cause of death
CDC Split Type: OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


VAERS ID: 28873 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1991-01-28
Onset:1991-01-30
   Days after vaccination:2
Submitted: 1991-02-12
   Days after onset:13
Entered: 1991-03-07
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


VAERS ID: 28906 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1989-12-08
Onset:1989-12-27
   Days after vaccination:19
Submitted: 1991-02-27
   Days after onset:427
Entered: 1991-03-08
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471P / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Finlepsen (Carbamazepine)
Current Illness: NONE
Preexisting Conditions: Epilepsy listed in autopsy as basic cause of death.
Allergies:
Diagnostic Lab Data: pt did not seek medical attention. No tests performed p/vax was administered.
CDC Split Type:

Write-up: Five days p/MMR vax was administered, pt experienced recurring headaches which continued until her death.


VAERS ID: 29133 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1991-02-11
Onset:1991-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP271 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had concommitent URI sx per mom 1-2 days prior to SIDS event.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 7 days after receiving 1st DTP immun.


VAERS ID: 29143 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:1990-11-25
Onset:1990-12-01
   Days after vaccination:6
Submitted: 1991-03-07
   Days after onset:96
Entered: 1991-03-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Dysphonia, Myasthenic syndrome, Neoplasm malignant, Vocal cord paralysis
SMQs:, Anaphylactic reaction (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Non-haematological malignant tumours (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: considering myasthenia gravis as the etiology.CT SCAn &MRI of upper chest&neck initially-neg.F/U CT SCAN of upper chest:tumor involving SVC&both recurrent laryngeal nerves@thoracic inlet.
CDC Split Type: 914090008

Write-up: Bilat paramedian vocal cord paralysis reported in pt receiving Fluogen. Had flu vax in Nov90 & became hoarse late Dec90. Seen mid Jan & found to have bilat paramedian vocal cord paralysis. As of 18Feb91, pt better. Dx=myasthenia gravis?


VAERS ID: 29150 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:1990-10-24
Onset:1990-10-26
   Days after vaccination:2
Submitted: 1990-11-20
   Days after onset:25
Entered: 1991-03-15
   Days after submission:115
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11200 / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Cardiac failure, Myocardial infarction
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MN90002

Write-up: Admitted to hosp on 26OCT90 died on 26OCT90; MI w/cardiac arrest.


VAERS ID: 29256 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1991-03-01
Onset:1991-03-02
   Days after vaccination:1
Submitted: 1991-03-05
   Days after onset:3
Entered: 1991-03-21
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC Split Type: 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


VAERS ID: 29272 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-30
Onset:1991-02-25
   Days after vaccination:26
Submitted: 1991-03-08
   Days after onset:11
Entered: 1991-03-22
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS Death;


VAERS ID: 29345 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-28
Onset:1991-02-03
   Days after vaccination:6
Submitted: 1991-02-16
   Days after onset:13
Entered: 1991-03-25
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 289945 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91529

Write-up: Crib Death- SIDS;


VAERS ID: 29348 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-03-08
Onset:1991-03-10
   Days after vaccination:2
Submitted: 1991-03-21
   Days after onset:11
Entered: 1991-03-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-03-12
   Days after onset: 2
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: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC Split Type:

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


VAERS ID: 29350 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:1990-11-07
Onset:1990-11-10
   Days after vaccination:3
Submitted: 1991-03-22
   Days after onset:132
Entered: 1991-03-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 4 - / A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-29
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 49 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC Split Type:

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


VAERS ID: 29397 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-02-27
Onset:1991-02-28
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:8
Entered: 1991-03-27
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M2053P / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: None apparent
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Bloodwork & Urinalysis - normal
CDC Split Type: PA9186

Write-up: Fever to 104 27FEB91 & 105 28FEB91; To ER 28FEB91; No apparent infect; Had red blotching on face 1MAR91 p/taking Augmentin was discontinued due to poss allergy; continues to have low grade fever & has clear nasal discharge.


VAERS ID: 29403 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1990-12-26
Onset:1991-01-10
   Days after vaccination:15
Submitted: 1991-01-10
   Days after onset:0
Entered: 1991-03-27
   Days after submission:76
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283936 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead in bed;


VAERS ID: 32491 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:1991-08-01
Submitted: 0000-00-00
Entered: 1991-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure, Drug ineffective
SMQs:, Cardiac failure (narrow), Lack of efficacy/effect (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hemodialysis pt, hypertension, diabetes.
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: EBU910189

Write-up: Pt vax w/ 3 doses hepta B; did not respond. Outcome no sequelae.


VAERS ID: 29431 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1991-03-15
Onset:1991-03-21
   Days after vaccination:6
Submitted: 1991-03-22
   Days after onset:1
Entered: 1991-03-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FP / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295948 / 1 MO / PO

Administered by: Private       Purchased by: Private
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: 1991-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: prior 2-3 wks bronchitis-now over
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy -SIDS
CDC Split Type:

Write-up: Sudden arrest /p feeding @ baby sitters. DOA 6 days /p vaxs. Baby was fine before, mother went to work. With baby sitter. Autopsy prelim DX-SIDS death, no abnormalities found


VAERS ID: 29463 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-17
Onset:1991-01-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-02
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


VAERS ID: 29477 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1991-02-21
Onset:1991-02-21
   Days after vaccination:0
Submitted: 1991-03-08
   Days after onset:15
Entered: 1991-04-01
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Hypotonia, Injection site pain, Pallor, Pyrexia, Sudden infant death syndrome
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-26
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: possible sids autospy report pending
CDC Split Type: TX9122

Write-up: Child mild fever & pain @ inject site; woke up crying; Limp & pale mom not certain if baby was breathing resuscitated poss SIDS;


VAERS ID: 29485 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-25
Onset:1991-02-16
   Days after vaccination:22
Submitted: 1991-03-21
   Days after onset:33
Entered: 1991-04-01
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283970 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91532

Write-up: SIDS


VAERS ID: 29488 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-03-25
Onset:1991-03-26
   Days after vaccination:1
Submitted: 1991-03-29
   Days after onset:3
Entered: 1991-04-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21000 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac Arrest noted 26MAR @ approx 7PM; Brought to ER-Resuscitation efforts did not help;


VAERS ID: 29754 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-01-22
Onset:0000-00-00
Submitted: 1991-02-05
Entered: 1991-04-05
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91012

Write-up: infant death-pending autopsy


VAERS ID: 29756 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-01-08
Onset:0000-00-00
Submitted: 1991-02-11
Entered: 1991-04-05
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91014

Write-up:


VAERS ID: 29769 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: South Carolina  
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted: 1991-03-25
Entered: 1991-04-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91032

Write-up:


VAERS ID: 29811 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:1990-10-19
Onset:1990-10-20
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:139
Entered: 1991-04-08
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


VAERS ID: 29812 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Texas  
Vaccinated:1991-03-06
Onset:1991-03-08
   Days after vaccination:2
Submitted: 1991-03-11
   Days after onset:3
Entered: 1991-04-08
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


VAERS ID: 29848 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-01-24
Onset:1991-02-19
   Days after vaccination:26
Submitted: 1991-04-06
   Days after onset:46
Entered: 1991-04-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none in pt or siblings~ ()~~~In patient
Other Medications: Naldec
Current Illness: nasal congestion
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: none
CDC Split Type: SD91009

Write-up: SIDS


VAERS ID: 30244 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Ohio  
Vaccinated:1990-11-28
Onset:1990-11-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1991-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 2 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205FD / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no problems with 1st DTP & OPV~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: No chronic illnesses
Allergies:
Diagnostic Lab Data: Autopsy Report 30NOV90 available-cause of death: SIDS
CDC Split Type: 900216701

Write-up: Morning p/immun, infant was found dead in her crib by babysitter, infant was blue, pulseless & apneic; transported by Ambulance to ER & pronounced dead; Cause-SIDS no sx to immun as fever or irritability, appeared healthy;


VAERS ID: 29892 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Maryland  
Vaccinated:1991-03-19
Onset:1991-03-22
   Days after vaccination:3
Submitted: 1991-04-09
   Days after onset:17
Entered: 1991-04-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis, Rhinitis, Sepsis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: VSD, Pulmonary artery stenosis;
Preexisting Conditions: premature, BW 3 13; 10 day of tx 2 birth for poss Sepsis stayed in Hosp 30 days- 1 day in oxygen;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt fine for 3 day; on 22MAR91 sleeping - sitter checked her & found her w/vomitus around her mouth & blue; Mom says she has runny nose the night prior to event; CPR was given there & in ambulance & ER but w/o result;


VAERS ID: 29894 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: California  
Vaccinated:1989-01-19
Onset:1989-02-18
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 1991-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / SCLAVO - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1989-12-21
   Days after onset: 306
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 29960 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-10-02
Onset:1990-10-09
   Days after vaccination:7
Submitted: 1991-01-14
   Days after onset:97
Entered: 1991-04-18
   Days after submission:93
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia
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), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC Split Type: MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


VAERS ID: 29967 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1991-03-21
Onset:1991-03-22
   Days after vaccination:1
Submitted: 1991-03-22
   Days after onset:0
Entered: 1991-04-19
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Congenital arterial malformation, Face oedema, Heart disease congenital
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Congenital, familial and genetic disorders (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


VAERS ID: 29978 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-02-14
Onset:1991-03-10
   Days after vaccination:24
Submitted: 1991-04-16
   Days after onset:36
Entered: 1991-04-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC Split Type:

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


VAERS ID: 29990 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-01-28
Onset:1991-01-30
   Days after vaccination:2
Submitted: 1991-04-02
   Days after onset:62
Entered: 1991-04-19
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283912 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH MC507B / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 910071301

Write-up: 2mos pt recvd DTP/OPV/Hibtiter on 28Jan91. Found in crib on 30Jan91-unable to resuscitate.No intervening illness.Preliminary autopsy report, no pathology, probable SIDS


VAERS ID: 30005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-03-26
Onset:1991-03-27
   Days after vaccination:1
Submitted: 1991-03-27
   Days after onset:0
Entered: 1991-04-22
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Rondec DM drops
Current Illness: mild stuffy nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC91024

Write-up: Reported crib death;


VAERS ID: 30020 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Kentucky  
Vaccinated:1991-01-14
Onset:0000-00-00
Submitted: 1991-02-07
Entered: 1991-04-22
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281929 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY918

Write-up: Reported - SIDS


VAERS ID: 30023 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Kentucky  
Vaccinated:1991-01-15
Onset:1991-02-13
   Days after vaccination:29
Submitted: 1991-02-19
   Days after onset:6
Entered: 1991-04-22
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618F / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Stupor
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY9111

Write-up: Child was found non responsive & with apnea 13FEB91 was taken the ER w/o successful resuscitation;


VAERS ID: 30116 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Dakota  
Vaccinated:1990-09-24
Onset:1990-10-07
   Days after vaccination:13
Submitted: 1991-04-04
   Days after onset:179
Entered: 1991-04-25
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NNE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: SD91012

Write-up: Coroner''s report consistent with SIDS baby was also fussy before put down for nap;


VAERS ID: 30143 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-02-27
Onset:1991-03-03
   Days after vaccination:4
Submitted: 1991-03-08
   Days after onset:5
Entered: 1991-04-26
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291947 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Infant had an ear infect 2 wks prior vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9153

Write-up: Autopsy performed, cause of death determined to be sudden infant death synd;


VAERS ID: 30208 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1991-03-20
Onset:1991-03-27
   Days after vaccination:7
Submitted: 1991-04-12
   Days after onset:15
Entered: 1991-04-29
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Anticholinergic syndrome (broad), 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: 1991-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


VAERS ID: 30232 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Montana  
Vaccinated:1991-02-21
Onset:1991-02-24
   Days after vaccination:3
Submitted: 1991-04-25
   Days after onset:59
Entered: 1991-04-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / 3 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac failure, Delirium
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Ammonia 711
CDC Split Type:

Write-up: Death from Reyes synd on 24FEB91 & presented to ER in full arrest & was not resuscitative;


VAERS ID: 30241 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-04-02
Onset:1991-04-04
   Days after vaccination:2
Submitted: 1991-04-04
   Days after onset:0
Entered: 1991-04-29
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC Split Type: CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


VAERS ID: 30254 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1990-12-17
Onset:1990-12-19
   Days after vaccination:2
Submitted: 1991-03-18
   Days after onset:89
Entered: 1991-05-02
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Acetaminophen
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA9141

Write-up: Rec''d vax 17DEC90 p/well child screen; Infant died on 19DEC90 mom reports giving acetaminophen every 6 hrs & that infant''s fretfullness was not unusual or different fr her other children following immun; Cause of death SIDS;


VAERS ID: 30365 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-02-26
Onset:1991-03-06
   Days after vaccination:8
Submitted: 1991-03-07
   Days after onset:1
Entered: 1991-05-10
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy ordered
CDC Split Type: TN9172

Write-up: Found dead;


VAERS ID: 30366 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Tennessee  
Vaccinated:1988-12-15
Onset:1988-12-15
   Days after vaccination:0
Submitted: 1991-04-09
   Days after onset:844
Entered: 1991-05-10
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 223925 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 232923 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1988-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9173

Write-up: Sudden Infant Death Syndrome;


VAERS ID: 30386 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-05-02
Onset:1991-05-05
   Days after vaccination:3
Submitted: 1991-05-06
   Days after onset:1
Entered: 1991-05-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Healthy infant found dead in crib by parents


VAERS ID: 30428 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:1991-01-28
Onset:1991-01-29
   Days after vaccination:1
Submitted: 1991-01-30
   Days after onset:1
Entered: 1991-05-13
   Days after submission:102
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Haemorrhage, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: 1991-01-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


VAERS ID: 30429 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-03-12
Onset:1991-03-13
   Days after vaccination:1
Submitted: 1991-04-18
   Days after onset:35
Entered: 1991-05-13
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


VAERS ID: 30447 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1991-04-12
Entered: 1991-05-13
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 184666 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910080301

Write-up: 4yo child died fr Haemophilus Meningitis 1991; Immunized 2 yrs ago in 1989;


VAERS ID: 30450 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-04-23
Onset:1991-04-24
   Days after vaccination:1
Submitted: 1991-04-26
   Days after onset:2
Entered: 1991-05-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0268B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910090301

Write-up: 2mo infant rec''d DTP/OPV/HIBTITER on 23APR91; Found dead at the babysitter''s 24APR91;


VAERS ID: 30604 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted: 1991-05-09
Entered: 1991-05-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


VAERS ID: 30620 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: Nebraska  
Vaccinated:1991-03-14
Onset:1991-03-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1991-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 5 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626H / 5 - / -

Administered by: Public       Purchased by: Public
Symptoms: Diabetes mellitus, Ketosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-31
   Days after onset: 4
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NE918

Write-up: Death dx - diabetic ketoacidosis;


VAERS ID: 30667 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1991-05-03
Onset:1991-05-07
   Days after vaccination:4
Submitted: 1991-05-14
   Days after onset:7
Entered: 1991-05-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 2 MO / PO

Administered by: Private       Purchased by: Private
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: 1991-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: pt was finishing course of Ceclor
Current Illness: resolving otitis media
Preexisting Conditions: rt hydrocele
Allergies:
Diagnostic Lab Data: Autopsy done 7May91.Provisional Anatomic Diagnoses:Consistent /w SIDS
CDC Split Type:

Write-up: Pt recvd immun on 3May91,@time of 4mo well baby checkup.Pt was seen in ER on 7May91 @ 630am in cardiac & respiratory arrest as an apparent SIDS death & pronounced dead /p CPR attempts.


VAERS ID: 30808 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-05-08
Onset:1991-05-10
   Days after vaccination:2
Submitted: 1991-05-17
   Days after onset:7
Entered: 1991-05-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M1204A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297957 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Diarrhoea, Polyuria
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Intolerant to CM & Soy formulas x/soyalac
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt rec''d initial DPT/OPV/HIB developed fretful later the same day, rec''d APAP; Stools seemed loose; child voided more than usual; But looked OK next day, died unexpectedly in sleep;


VAERS ID: 30812 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted: 1991-05-17
Entered: 1991-05-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC Split Type: SC91056

Write-up: Pt died on 14MAR91;


VAERS ID: 30822 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Ohio  
Vaccinated:1991-03-26
Onset:1991-04-01
   Days after vaccination:6
Submitted: 1991-04-19
   Days after onset:17
Entered: 1991-05-24
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295943 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910085101

Write-up: 5mo child rec''d shot''s 26MAR91; child died on 1APR91; Coroner''s report was SIDS; child had tracheal malacia & had been sick so this was first DTP; Second OPV;


VAERS ID: 30833 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-01-04
Onset:0000-00-00
Submitted: 1991-04-22
Entered: 1991-05-24
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: slow weight gain
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA910503

Write-up: SIDS; Death 28JAN91;


VAERS ID: 30844 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Dakota  
Vaccinated:1991-04-03
Onset:1991-04-08
   Days after vaccination:5
Submitted: 1991-05-14
   Days after onset:36
Entered: 1991-05-24
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 614E1 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Brother reacted to DTP in 1988;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report attached
CDC Split Type: SD91015

Write-up: Child was admitted to Hosp on 9MAR91 by MD for resp problems (apnea); D/C 13MAR91 & was fine;


VAERS ID: 30887 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-04-22
Onset:1991-05-11
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 1991-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295955 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: No other drugs noted
Current Illness:
Preexisting Conditions: prior sib died of myocarditis
Allergies:
Diagnostic Lab Data: Preliminary post mortem reort viral pneumonia
CDC Split Type:

Write-up: Infant rec''d DTP/OPV on 22APR91 no adverse rxn noted; In next 48hrs-infant went to slep 11MAY91 & appeared well; found dead in bed p/nap;


VAERS ID: 30908 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Alabama  
Vaccinated:1990-12-10
Onset:1990-12-13
   Days after vaccination:3
Submitted: 1990-12-19
   Days after onset:6
Entered: 1991-05-31
   Days after submission:162
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pronchopulmonary Dysplasia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden infant death; Child seemed well at 4AM feeding 13DEC90 was found dead in crib 8AM 13DEC90; Child had Bronchopulmonary Dysplasia;


VAERS ID: 30928 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1991-04-22
Onset:1991-04-23
   Days after vaccination:1
Submitted: 1991-04-24
   Days after onset:1
Entered: 1991-06-03
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914I / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295932 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Postmortem Autopsy
CDC Split Type: OR9115

Write-up: Infant given DTP/HIB/OPV; sl elv fever & irritability that PM, then infant died in sleep during nap the next day; (SIDS); 0 sz or other activity noted;


VAERS ID: 31005 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1991-01-22
Entered: 1991-06-04
   Days after submission:132
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Gastroenteritis, Hepatic failure
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy dx: Alper''s synd (combined cerebrohepatic degeneration) autopsy report requested;
CDC Split Type: 910015001

Write-up: Child had sz five days p/immun following a brief viral gastroenteritis; tx w/mutiple anticonvulsants, barbiturate coma, brain biopsy, & eventually hemispherectomy; Went into fulminant liver failure & died; Autopsy dx: alper''s synd;


VAERS ID: 31289 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1991-05-31
Onset:1991-06-03
   Days after vaccination:3
Submitted: 1991-06-08
   Days after onset:5
Entered: 1991-06-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 629B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt died of SIDS 3 days following administration of vax;


VAERS ID: 31354 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1990-12-17
Onset:1990-12-24
   Days after vaccination:7
Submitted: 1991-01-25
   Days after onset:32
Entered: 1991-06-17
   Days after submission:142
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SIDS
CDC Split Type: GA91133

Write-up: SIDS;


VAERS ID: 31355 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1991-03-06
Onset:1991-03-09
   Days after vaccination:3
Submitted: 1991-03-28
   Days after onset:19
Entered: 1991-06-17
   Days after submission:80
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FM / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: GA91134

Write-up: SIDS;


VAERS ID: 31356 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1991-04-04
Onset:1991-04-09
   Days after vaccination:5
Submitted: 1991-05-28
   Days after onset:49
Entered: 1991-06-17
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295971 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624C / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: poor wt gain w/breast feeding
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: GA91135

Write-up: SIDS;


VAERS ID: 31377 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1991-06-06
Onset:1991-06-07
   Days after vaccination:1
Submitted: 1991-06-12
   Days after onset:5
Entered: 1991-06-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293949 / 2 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 2 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 293938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: well growing baby
CDC Split Type:

Write-up: Pt @ 4 mo of age on 6Jun91 recvd DPT/OPV/HIBV.There were no reported fever, anaphylaxis, sz but pt died of SIDS on 7Jun91 evening.Found dead in basinet by mom


VAERS ID: 31378 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Jersey  
Vaccinated:1991-03-13
Onset:1991-03-22
   Days after vaccination:9
Submitted: 1991-06-10
   Days after onset:79
Entered: 1991-06-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: atopic dermatitis
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: R/O sudden infant death synd.Autopsy performed
CDC Split Type:

Write-up: Recvd Hib titer vax 13Mar91. On 22Mar91 the pt was brought to ER. Dead on arrival


VAERS ID: 31415 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Alaska  
Vaccinated:1991-02-28
Onset:1991-03-28
   Days after vaccination:28
Submitted: 1991-06-13
   Days after onset:76
Entered: 1991-06-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-26
   Days after onset: 58
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC Split Type: WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


VAERS ID: 31684 (history)  
Form: Version 1.0  
Age: 34.0  
Sex: Male  
Location: Iowa  
Vaccinated:1990-11-01
Onset:1990-11-18
   Days after vaccination:17
Submitted: 1991-06-03
   Days after onset:196
Entered: 1991-06-24
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Vascular occlusion
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-10
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC Split Type: IA910018

Write-up: Cervical spine cord infarction & subsequent death;


VAERS ID: 31738 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Alaska  
Vaccinated:1991-02-25
Onset:1991-03-06
   Days after vaccination:9
Submitted: 1991-06-20
   Days after onset:105
Entered: 1991-06-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Bradycardia, CSF test abnormal, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-10
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC Split Type: WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


VAERS ID: 31981 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:1991-04-28
Submitted: 1991-05-30
   Days after onset:32
Entered: 1991-07-01
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M1607H / 3 - / L
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Copy of police report & Autopsy;
CDC Split Type: MS9127

Write-up: Pt was found dead @ aunt''s home--in twin size bed, by foot of the bed--between rail on foot & mattress;


VAERS ID: 32168 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Kansas  
Vaccinated:1990-10-23
Onset:1990-10-25
   Days after vaccination:2
Submitted: 1991-06-26
   Days after onset:244
Entered: 1991-07-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620F / UNK MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1990-10-25
   Days after onset: 0
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden infant death; Taken to hosp by ambulance; Assessment: critically ill child w/significant metabolic acidosis due to some unk event; Most likely aspiration which caused cardiopulmonary arest;


VAERS ID: 32264 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kansas  
Vaccinated:1991-04-04
Onset:1991-04-29
   Days after vaccination:25
Submitted: 1991-05-03
   Days after onset:4
Entered: 1991-07-08
   Days after submission:66
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M565FP / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: KS9126

Write-up: NONE KNOWN; Autopsy dx of SIDS;


VAERS ID: 32297 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-04-25
Onset:1991-04-27
   Days after vaccination:2
Submitted: 1991-05-08
   Days after onset:11
Entered: 1991-07-08
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiomegaly, Cerebral ischaemia, Hepatosplenomegaly, Infection, Myocarditis, Pneumonia, Screaming, Supraventricular tachycardia
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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: 1991-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 3MAR91 dx viral synd; 12MAR91 resolved viral synd; nasal congestion;
Allergies:
Diagnostic Lab Data: Autopsy by Hosp
CDC Split Type: TN9194

Write-up: Pt was irritable & cried & cried all day; Ambulance called but not taken to Hosp; Later seen in ER & died; MD states death had to do w/chambers of the heart & mixing of blood Death certificate states cardiac failure;


VAERS ID: 32527 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-04-24
Onset:1991-04-25
   Days after vaccination:1
Submitted: 1991-04-26
   Days after onset:1
Entered: 1991-07-12
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300922 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295932 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Hypertonia
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pt given DTP/OVP 14FEB91;
Current Illness: NONE
Preexisting Conditions: pneumonia 26MAR, Rx EES x 10d (recovered)
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: PA91186

Write-up: Parents fed infant @ 430AM, put back to bed; Went in between 5-6AM, found Pt face down, stiff- called 911 prononuced dead @ 851AM;


VAERS ID: 32592 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-06-27
Onset:1991-07-08
   Days after vaccination:11
Submitted: 1991-07-10
   Days after onset:2
Entered: 1991-07-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304919 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 632C5 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gross = SIDS; Coroner report pending
CDC Split Type:

Write-up: Apparent SIDS 8JUL91;


VAERS ID: 32649 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Indiana  
Vaccinated:1991-04-16
Onset:1991-04-18
   Days after vaccination:2
Submitted: 1991-05-01
   Days after onset:13
Entered: 1991-07-18
   Days after submission:78
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M565SP / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297945 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: pending
CDC Split Type: IN9118

Write-up: Pt appeared normal & hlthy. Put down for nap, found dead later. DX: SIDS by medical examiner


VAERS ID: 32678 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-03-05
Onset:1991-04-01
   Days after vaccination:27
Submitted: 1991-07-01
   Days after onset:90
Entered: 1991-07-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291947 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS death 1APR91;


VAERS ID: 32774 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1991-03-06
Onset:1991-03-07
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:1
Entered: 1991-07-22
   Days after submission:135
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M60FC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt was premature delivery at 31.5; corrected 35 wk gest; hip click & small umbical hernia;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA9178

Write-up: Pt recvd vax 6MAR91 next day put to bed around 10AM & returned to room to check on between 1130-12pm pt was not responsive; Taken to Hosp ER; pathologic dx SIDS;


VAERS ID: 32819 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: South Dakota  
Vaccinated:1991-02-04
Onset:1991-02-07
   Days after vaccination:3
Submitted: 1991-07-15
   Days after onset:157
Entered: 1991-07-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 293950 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291976 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: SD91022

Write-up: SIDS;


VAERS ID: 32875 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Male  
Location: Kansas  
Vaccinated:1991-04-05
Onset:1991-04-06
   Days after vaccination:1
Submitted: 1991-07-11
   Days after onset:95
Entered: 1991-07-25
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 4 - / IM L

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: strep pneumo Sepsis
CDC Split Type: KS9145

Write-up: Pt devel temp 1 day post vax persisted for 2 days; Admitted for Sepsis & expired the same day;


VAERS ID: 33051 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: California  
Vaccinated:1990-08-16
Onset:1990-08-16
   Days after vaccination:0
Submitted: 1991-07-24
   Days after onset:342
Entered: 1991-07-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military       Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


VAERS ID: 33131 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Virginia  
Vaccinated:1991-07-08
Onset:1991-07-20
   Days after vaccination:12
Submitted: 1991-07-23
   Days after onset:3
Entered: 1991-08-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300923 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304958 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type: VA91062

Write-up: Autopsy showed cause of death natural; found in crib;


VAERS ID: 33132 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-04-15
Onset:1991-05-04
   Days after vaccination:19
Submitted: 1991-06-14
   Days after onset:41
Entered: 1991-08-01
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297957 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Encephalitis, 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), Noninfectious encephalitis (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-07
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Multi-vits w/flouride
Current Illness: NONE
Preexisting Conditions: Hemangioma lt lower eyelid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden infant death syndrome;


VAERS ID: 33434 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-07-18
Onset:1991-07-24
   Days after vaccination:6
Submitted: 1991-07-25
   Days after onset:1
Entered: 1991-08-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300922 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 300949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE-hx of congenital rx MAY91
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA91248

Write-up: Mom fed pt approx 530AM; Returned to check on pt 11AM; Pt unresponsive; Called EMS; 24JUL91 DOA 1130-12PM; SIDS?


VAERS ID: 33574 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1991-07-23
Onset:1991-07-25
   Days after vaccination:2
Submitted: 1991-08-01
   Days after onset:7
Entered: 1991-08-12
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0633C / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy requested
CDC Split Type: OR9134

Write-up: Pt immun 23JUL91 & had SIDS on 25JUL91;


VAERS ID: 33687 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Jersey  
Vaccinated:1990-07-12
Onset:0000-00-00
Submitted: 1991-08-02
Entered: 1991-08-13
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271962 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277940 / UNK MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cyanosis, Endocrine disorder, Haemorrhage, Infection, Injection site mass, Lung disorder, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Extravasation events (injections, infusions and implants) (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), 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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910145401

Write-up: Claimant''s attorney reports that child is deceased; No other info is provided;


VAERS ID: 33906 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1991-07-23
Onset:1991-08-01
   Days after vaccination:9
Submitted: 1991-08-07
   Days after onset:6
Entered: 1991-08-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21001 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302941 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Dislocated hips-bilateral
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 1AUG91;


VAERS ID: 33907 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1991-08-02
Onset:1991-08-08
   Days after vaccination:6
Submitted: 1991-08-15
   Days after onset:7
Entered: 1991-08-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297907 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 300941 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt found dead in bed-SIDS;


VAERS ID: 34077 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-08-01
Onset:1991-08-07
   Days after vaccination:6
Submitted: 1991-08-15
   Days after onset:8
Entered: 1991-08-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH A2200 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laryngitis, Pallor, Petechiae, Splenomegaly, Stupor, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 6 days p/vax, pt found in crib in AM unresponsive & ashen; To ER; complete arrest;


VAERS ID: 34139 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1991-08-08
Onset:1991-08-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1991-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21031 / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HE / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 638K / 1 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-08-11
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: umbilical hernia
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3924

Write-up: Probable SIDS; died 72 hrs post-vax;


VAERS ID: 34373 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:1991-04-17
Onset:1991-04-20
   Days after vaccination:3
Submitted: 1991-04-22
   Days after onset:2
Entered: 1991-08-29
   Days after submission:129
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC Split Type: NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


VAERS ID: 34471 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Female  
Location: Georgia  
Vaccinated:1991-08-13
Onset:1991-08-14
   Days after vaccination:1
Submitted: 1991-08-23
   Days after onset:9
Entered: 1991-09-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Acidosis, Convulsion, Haemorrhage, Marrow hyperplasia, Necrosis, Petechiae, Splenomegaly, Thrombotic thrombocytopenic purpura
SMQs:, Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Renovascular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: few petechia on back, abd, legs
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91239

Write-up: Mom called 19AUG91 reporting pt started w/diarrhea, fever? (no thermometer), sleeping a lot on 14AUG91; rash on 18AUG91 & was advised to seek med eval that day; Did not go for care until pt collapsed @ home p/MN; Taken to ER, where pt died;


VAERS ID: 34472 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1991-04-16
Onset:1991-04-18
   Days after vaccination:2
Submitted: 1991-04-19
   Days after onset:1
Entered: 1991-09-03
   Days after submission:137
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281947 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC Split Type: GA91240

Write-up: No sx until 18APR91; pt became a little fussy, no fever; pt settled down by bedtime & mom thought pt was sleeping; Mom found pt dead AM of 19APR91;


VAERS ID: 34482 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-07-31
Onset:1991-08-01
   Days after vaccination:1
Submitted: 1991-08-02
   Days after onset:1
Entered: 1991-09-03
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-medical examiner 2AUG91
CDC Split Type: NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


VAERS ID: 34563 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted: 1991-08-29
Entered: 1991-09-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-06
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Not known; SIDS


VAERS ID: 34628 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-04-19
Onset:1991-04-20
   Days after vaccination:1
Submitted: 1991-07-15
   Days after onset:86
Entered: 1991-09-10
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21000 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297950 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Bradycardia, 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: 1991-05-14
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Caffeine, Polyvisol
Current Illness: NONE
Preexisting Conditions: prematurity, obstructive apnea
Allergies:
Diagnostic Lab Data: See admission H & P
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB evening 19APR91 & returned to office w/profound apnea & bradycardia requiring mechanical ventilation 20APR91 @ 930AM; Pt expired 14MAY91 of cardio-respiratory arrest p/transfer there on 20APR91;


VAERS ID: 34856 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:1988-10-20
Onset:1989-02-05
   Days after vaccination:108
Submitted: 1991-08-28
   Days after onset:933
Entered: 1991-09-19
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-02-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: 910162901

Write-up: Plaintiffs allege that as a result of vax on or p/20OCT88, pt died on 5FEB89; No addtl info is provided;


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