National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Found 8,467 cases where Patient Died

Case Details

This is page 27 out of 85

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


VAERS ID: 265666 (history)  
Form: Version 1.0  
Age: 0.01  
Sex: Female  
Location: New Hampshire  
Vaccinated:2006-02-28
Onset:2006-03-20
   Days after vaccination:20
Submitted: 2006-10-31
   Days after onset:225
Entered: 2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB194AA / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH0608

Write-up: Undetermined Category II SIDS, WCC 3/9/06 PE exam WNL.


VAERS ID: 265696 (history)  
Form: Version 1.0  
Age: 0.01  
Sex: Female  
Location: California  
Vaccinated:2006-08-19
Onset:2006-08-21
   Days after vaccination:2
Submitted: 2006-10-31
   Days after onset:71
Entered: 2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / -

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: 2006-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin K
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full-term, healthy baby with no symptoms and no risk factors died within days of receiving HepB vaccine. Extensive second autopsy by SIDS specialist/pathologist found no cause of death and no abnormalities; death was attributed to SIDS.2/20/07 Received autopsy report which reveals COD as consistent with SIDS.


VAERS ID: 265901 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2006-10-31
Onset:2006-11-02
   Days after vaccination:2
Submitted: 2006-11-02
   Days after onset:0
Entered: 2006-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS 2F601311 / UNK RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Thyroid, Protonix, Detral, Premarin, Colestid
Current Illness:
Preexisting Conditions: Allergies: Penicillin, Tetracycline. Medical Conditions: Several
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown. Patients husband came pharmacy at ~ 12pm 11/02 mentioning that his wife had passed away in the evening. Pharmacist manager is a friend of the family and relayed on information on to myself that was running a flu clinic at that location today. 11/9/06 Received Death Certificate which reveal COD as ischemic heart disease and HTN with insomnia, hypothyroidism and chronic bronchitis as contributing factors.


VAERS ID: 266012 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2006-10-05
Onset:0000-00-00
Submitted: 2006-11-04
Entered: 2006-11-06
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2240AA / 1 LA / -

Administered by: Other       Purchased by: Private
Symptoms: Respiratory disorder, Respiratory tract infection
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-10-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s father came in; said patient felt ill, went to emergency room, got hospitalized for respiratory problem/infection and died day(?) shortly afterward. 11/20/06 Received medical records from hospital which indicate patient seen 10/13/06 with altered mental status, SOB, nausea, vomiting. Seen in local clinic & dx w/HTN. Patient coded outside ER where he had been brought by his parents. Code/intubation were successful. NGT revealed coffee ground gastric contents. LABS: WBC 41,800, H/H 9.3/26.3, plts 119,000. Na 110, K5.5, BUN/creat 108/3.9, cl 76. Troponin 0.16. Calcium 5.7. Beta natriuretic peptide 1570. ABG showed metabolic acidosis. CXR revealed cardiomegaly w/pulmonary congestion consistent w/CHF & RLL pneumonia. Patient expired 10/23/06 when he coded again while on his way to OR for trach. No autopsy was done. DX: cardiopulmonary arrest s/p successful resuscitation; Gram neg septic shock, acute renal failure; metabolic acidosis; hypocalcemia; ARDS; multi system organ failure; & UGI bleeding. 12/1/06 Received death certificate which reveals COD as acute cardiopulmonary arrest, septic shock & hypertension.


VAERS ID: 266205 (history)  
Form: Version 1.0  
Age: 1.09  
Sex: Male  
Location: Texas  
Vaccinated:2006-11-02
Onset:2006-11-02
   Days after vaccination:0
Submitted: 2006-11-07
   Days after onset:5
Entered: 2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-11-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC Split Type:

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


VAERS ID: 266239 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:2006-10-17
Onset:0000-00-00
Submitted: 2006-11-07
Entered: 2006-11-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE009AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08653R / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0776F / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-10-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Birth HX: Birth: 8 lbs, 12 oz, ht 21, head circ 16. Noted to have a rash on initial exam. Dx Infant dermatitis & treated. OB/GYN of mother records from pcp reveals Mom was 23yo, g4, p2 with PMH of gonorrhea & chlamydia, HSV I & II, Grp B strep.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On call doctor was called on 10/23/06 that the pt was brought to ER (hospital) and pt was dead already. History of diarrhea and vomiting. 11/14/06 Received medical records from PCP including med record from OB/GYN of mother which reveals Mom was 23yo, g4, p2 with PMH of gonorrhea & chlamydia, HSV I & II, Grp B strep. Developed thrush on 8/25/06 visit & treated. On 10/17 date of vax visit weight was 12 lbs 9 oz, length 23, head 15.5. Child was noted to be healthy at that time. 6/12/07 Received autopsy report which reveals COD as dehydration due to gastroenteritis & manner of death as natural. Dehydration from severe diarrhea was contributing factor. Parent reported patient had been vomiting along w/diarrhea since 10/21 (received vaccines on 10/17). Parent also admitted to use of drugs (crank) up until her 5th month of pregnancy when prenatal care began. Parent reported that allergy to formula may have been contributory as patient was on his 3rd type of formula. Coroner investigation reveals no milk allergy was reported in pcp medical records.


VAERS ID: 266240 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Male  
Location: Michigan  
Vaccinated:2006-10-25
Onset:2006-10-27
   Days after vaccination:2
Submitted: 2006-11-02
   Days after onset:6
Entered: 2006-11-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B05AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0404F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655C / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac
Current Illness:
Preexisting Conditions: Gastroesopheal Reflux, 35 week preterm infant.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death about 2 days after 4 month vaccination, no apparent cause know. Autopsy pending.


VAERS ID: 266257 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Male  
Location: Maryland  
Vaccinated:2004-12-02
Onset:2004-12-03
   Days after vaccination:1
Submitted: 2006-11-08
   Days after onset:705
Entered: 2006-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Bronchiolitis, Cough, Hypotonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2004-12-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synagis
Current Illness: Cold, cough, fever (Doctor''s office said there was no fever, but he had a fever at home prior to appointment.)
Preexisting Conditions: Premature
Allergies:
Diagnostic Lab Data: Autopsy report: I''m still waiting for my copy, which I had to send for in writing. On 12/03/2004, I was told that there would be a police report and an autopsy which is standard procedure in the death of an infant. I told them I was glad, and that I was anxious to find out if the immunizations were the cause of death. Weeks later, I was given verbal results over the phone. After they told me all of the things that did NOT cause his death, they said that they were listing the cause as "unknown natural causes" and later they had to change it to SIDS because they had to put something other than "unknown" When I asked about the results of the test for reaction to vaccines, she said they didn''t test for that. I was shocked and disappointed, because for us, that was the most important test to be given!
CDC Split Type:

Write-up: 12/01/04: Dry cough, fever; seen at Dr''s office. Diagnosed with "bronchiotitis." No medication prescribed. Advised to use humidifier. 12/02/04: Synagis shot given at home by hospise nurse. This was a regular procedure since he was premature. 12/02/04: I called doctor''s office to cancel "well baby" appointment, because he had just been seen the day before for a bad cough. I didn''t think he should keep his appointment for his immunizations when he was this sick. The nurse said that if I didn''t keep the appointment that we would be dropped as a patient and charged for a missed appointment. I said that typically with my other children, doctors don''t want to give immunizations when the child is sick and tell me to reschedule well-baby appointments. I took him in because of her threats. He was seen by the doctor that day. I re-stated my concern about giving him immunizations when he was sick. He convinced me that it would be fine. He was given four more shots that day (listed below) 12/03/2004: My husband and I were up early because he had an early day at work. (4 am) When I checked on him, he seemed to be sleeping in an odd position. When I went to adjust him, his head fell back and he was limp and not breathing. We called 911. While we waited for the ambulance, they told me to breathe softly into his mouth. I did with no response. In the emergency room, they tried to revive him, but he died.


VAERS ID: 266512 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Colorado  
Vaccinated:2006-11-04
Onset:2006-11-07
   Days after vaccination:3
Submitted: 2006-11-10
   Days after onset:3
Entered: 2006-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2255AA / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood creatine phosphokinase increased, Malaise, Platelet count decreased, Renal failure, Respiratory failure, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-10
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pre diabetes, Hyperlipidemia.
Allergies:
Diagnostic Lab Data: WBC 44.2, Platelets 51,000, ALT 698, AST 1596, Sodium 132, Creatine 3.7.
CDC Split Type:

Write-up: Healthy 82 yo male well at physical exam 10/31/06. Received flu vaccine mass immunization 11/04*06, Ill on Mon-Tues 11/6-7, Admitted to hospital 11/07/06. Steven Johnson Syndrome, Renal and respiratory failure and death on 11/9/06. 11/20/06 Received medical records from hospital which reveal patient admitted 11/7/06-11/9/06 for hypoxia then quickly developed a macular, then petechial associated with circumoral desquamation, very concerning for Stevens Johnson syndrome. Patient had fever (103-104)/chills, myalgias, DOE w/dry cough, 5# weight loss over 1 week & weakness for approx 1 week prior to admit. Also had tooth abscess approx 5 days prior to admit for which he did not receive antibiotics. ID & resp consults done. No death certificate included. PMH: hyperlipidemia & pre diabetes. LABS: CXR revealed bilat infiltrates w/effusion. WBC 12.2, plts 40. Rapid influenza test was neg. Blood, urine & sputum cultures neg. Final DX: respiratory failure; sepsis, pneumonia, hypotension, renal failure, liver failure. 11/27/06 Received death certificate from funeral home which states COD as sepsis & pneumonia with acute renal failure as contributing factor.


VAERS ID: 266513 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2006-11-10
Entered: 2006-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: A0626900A

Write-up: This case was reported by a physician and described the occurrence of death unspecified in a subject of unspecified age and gender who was vaccinated with Dtap, Manufacturer unspecified, for prophylaxis. On an unspecified date approximately a year before 11/7/06, the subject received a dose of Dtap (dose number and lot number not provided). Approx one month after vaccination with Dtap, the subject died. Report received via manufacturer.


VAERS ID: 266544 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2006-10-17
Onset:2006-10-24
   Days after vaccination:7
Submitted: 2006-11-06
   Days after onset:13
Entered: 2006-11-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 70707 / 1 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-02
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxygen 2 liters, nebulizer four times a day, singular 10mg every morning, spiriva every morning, albuterol inhaler twice a day, advair 100/50 twice a day, Ibuprofen 200 mg as needed, Xanax 25 mg 1/2 tab by mouth as needed, B12 500mg liquid
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted to medical center 10/24/2006 for SOB and resp distress. No documented fever. Long standing H/O COPD. Pt expired 11/2/06 no autopsy done.


VAERS ID: 266776 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:2006-11-08
Onset:2006-11-14
   Days after vaccination:6
Submitted: 2006-11-14
   Days after onset:0
Entered: 2006-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0280F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674H / 1 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: UNKNOWN: RECEIVED CALL FROM MEDICAL EXAMINER OF BABYS DEATH TODAY. 3/22/07 Received Autopsy Report which reveals COD as undetermined & manner of death undetermined. Autopsy findings: single conjoined kidney; diffuse mild cerebral white matter gliosis; neg tox, micro & metabolic testing; focal glomerulosclerosis of unknown significance.


VAERS ID: 266851 (history)  
Form: Version 1.0  
Age: 0.01  
Sex: Female  
Location: Texas  
Vaccinated:2006-08-08
Onset:2006-08-12
   Days after vaccination:4
Submitted: 2006-11-15
   Days after onset:95
Entered: 2006-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB285AA / 1 RL / IM

Administered by: Public       Purchased by: Other
Symptoms: Haemorrhage, Petechiae, Unevaluable event
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-08-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin K 1mg IM given 8/6/06
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: T.bili at 35 hours of life 9.0. T.bili at 56 hours 13.3/ D.bili 0.2. Autopsy gross and microscopic showed only intrathoracic petechial hemorrages on parietal pleura and epicardium. Toxicology immunoassay and vitreous panel for electrolytes were normal. Normal newborn metabolic screen.
CDC Split Type:

Write-up: Patient died at home on 8/12/2006. Patient was cosleeping with parents. Breastfed at 3am and found dead next to mother at 6am, according to her mother. Autopsy ruled cause of death as undetermined.


VAERS ID: 267166 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2006-11-08
Onset:2006-11-10
   Days after vaccination:2
Submitted: 2006-11-17
   Days after onset:7
Entered: 2006-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / SANOFI PASTEUR Z0401 / 2 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Aphasia, Coma, Encephalitis, Hemiparesis, Paralysis, Quadriplegia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-11-21
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin, Musinex, Nexium, Lexapro
Current Illness: Bronchitis
Preexisting Conditions: GE reflux, kidney stones, sulpha allergy PMH: depression, anxiety, sleep apnea & GERD. Has aunt w/MS.
Allergies:
Diagnostic Lab Data: MRI - 11/15: diffuse cerebral white matter disease; process remains nonspecific given clinical circumstances; disseminated encephalomyelitis is possible. Viral encephalitis is perhaps possible, although cytotoxic ademia is usually a prominate feature of infectious encephalitis. LABS: CT at outlying hospital showed right temporoparietal edema, MRI possible glioma. CT at transfer hospital showed diffuse abnormal attenuation w/n the white matter likely due to diffuse vasogenic edema w/o definite area of abnormal enhancement or discrete mass identified. CXR showed prominent mediastinal contours. CT of chest was WNL. Repeat CT of brain 11/13 showed substantial progression of white matter disease suggesting ADEM. Repeat CT of brain showed minimal increase in edema but no CSF remaining in quadrigeminal plate & ambient cisterns w/diffuse sulcal effacement & decresed attenuation w/n cerebral white matter.
CDC Split Type:

Write-up: Two days following second dose of rabies vaccine, admitted to hospital w/ left side weakness, progressing rapidly to full paralysis and aphasia. Pts neurologic status has continued to decline. On November 16, quadrapoligic, unresponsive; intubated in Neural Intensive Care Unit. 3/15/07 Received medical records from hospital which reveal patient admitted 11/11/06-11/17/06. Received rabies vax on 11/1 & 11/8. Stated to ID consult that she received rabies vax every 3 yrs routinely while employed at vet office. Developed bronchitis on 11/4-5 & treated w/antibiotics beginning 11/6. Awoke w/hemiparesis (initially left then became bilateral), fever, HA, neck pain, photophobia, speech impairment, right leg tremors & N/V when sat up on 11/10. Seen at outlying hospital, admitted, treated w/steroids & IV antibiotics, then transferred on 11/11. Consults by neuro, neurosurg, ID, ICU & gen surg. Admitted to neuro ICU. Approx 4 hrs s/p admit, developed aphasia. Condition declined over next few days & began Cheyne-Stokes respiration & was intubated. Continued tx w/plasmapheresis, high dose steroids, dilantin, mannitol & Diamox. Severe hypotension tx w/pressors. Condition continued to deteriorate despite aggressive tx & pt expired on 11/17/06 s/p brain herniation. 3/15/2007 Received Autopsy Report forwarded via fax from CDC which reveals COD as ADEM s/p rabies vaccine.


VAERS ID: 267616 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2006-11-06
Onset:2006-11-06
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:15
Entered: 2006-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Private       Purchased by: Other
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: High blood pressure/diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother had a doctor''s appointment with MD for a flu shot 10:00 am on November 6, 2006. Immediately after the shot at approximately 11:00 am as they were driving away from the office she started gasping for breath, the paramedics were called and they never revived her.


VAERS ID: 267624 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2006-11-17
Entered: 2006-11-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Autonomic nervous system imbalance, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood urea increased, CSF test abnormal, Colitis, Demyelination, Dysphonia, Gamma-glutamyltransferase increased, Guillain-Barre syndrome, Inflammation, Polyneuropathy, Quadriplegia, Renal failure, Sepsis, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: FK506, Prednisone.
Current Illness:
Preexisting Conditions: The pt had a history of hypertension and alcoholic liver cirrhosis, for which he underwent orthotopic liver transplantation six months prior to admission. He denied any precedent episodes of diarrhea, nausea, vomiting, or other gastrointestinal or upper respiratory illness.
Allergies:
Diagnostic Lab Data: Electrodiagnostic studies showed prolonged distal latencies and absence of late responses in all extremities. The component muscle action potentials were reduced throughout with absence of component muscle action potential in the proximal tibial and peroneal nerves bilaterally. The conduction velocities were reduced in demyelination range in the median nerves bilaterally. There was a conduction block in median nerves bilaterally, in right ulnar and in right tibial nerves. These findings were consistent with acute inflammatory demyelination polyneuropathy. Due to size limitation of the lab comments field, the complete reported lab findings are entered in the single case comments field.
CDC Split Type: 200603086

Write-up: Initial information was received on 11/13/06 from the aforementioned literature citation. A 62 year old male pt, with a past medical history of hypertension and alcoholic liver cirrhosis, for which he underwent orthotopic liver transplantation, received an influenza vaccination on an unspecified date. The trade name, manufacturer or lot number were not reported. Two weeks after receiving the vaccine, the pt developed progressive generalized weakness and was diagnosed with Guillain [[name]]e Syndrome. He was seen in a hospital one week after the onset of symptoms, where he was found to have an elevated FK506 level (18.1 ng/ml, and the dose of FK506 was adjusted. His weakness worsened, and he was admitted to another hospital two weeks after th onset of the symptoms. The pts liver transplantation as six months prior to admission. Since then, he had been on FK506 and a low dose of prednisone without any complications. He denied any precedent episodes of diarrhea, nausea, vomiting, or other gastrointestinal or upper respiratory illness. Neurological examination on admission revealed normal mental status, bilateral facial weakness, dysphagia, hypophonia, quadriplegia ( 1-2/5 by Medical research council scale), throughout, and absence of muscle stretch reflexes in all extremities. Blood chemistry showed blood urea nitrogen 34 mg/dl, creatinine 0.9 g/dl, albumin 4.5 g/dl, aspartate aminotransferase 78 u/l, alanine aminotransferase 189 u/l, gamma glutamyl transpepitadase 160 u/l, alkaline phosphatase 146 mg/dl, total bilirubin 1.8 mg/dl, direct bilirubin 0.5 mg/dl, ammonia 47 ul/l, international normalized ration 0.91, and blood FK5506 level 7ng/ml. Serum immunoglobulin G was positive against herpes simplex virus 1, Epstein [[name]] virus and cytomeglaovirus, but neg against herpes simplex virus 2. Immunoglobulin M was neg against Epstein [[name]] virus and CMV in serum. The testing for Campylobacter Jejuni was not performed. Lumbar puncture revealed that the cerebrospinal fluid looked xanthochromic with red blood corpuscles 0/11^3, while blood cells 1/mm3, protein 358 mg/dl, glucose 88 mg/dl, lactic acid 2.7 mEq/l, and opening pressure of 25 cm cerebrospinal fluid. Cerebrospinal fluid venereal disease research lab slide test, gram stain, cyptococcal antigen, and cytology were neg. Herpes simplex virus, CMV, and Epstein [[name]] virus DNA were not detected by polymerase chain reaction test. Electrodiagnostic studies showed prolonged distal latencies and absence of late responses in all extremities. The component muscle action potential were reduced throughout with absence of component muscle action potential in the proximal tibial and peroneal nerves bilaterally. The conduction velocities were reduced in demyelination range in the median nerves bilaterally. There was a conduction block in median nerves bilaterally, in right ulnar and in right tibial nerves. These findings were consistent with acute inflammatory demyelination polyneuropathy. Shortly after admission, the pt was Intubated for airway protection and started on IV immunoglobulin 0.4 g/kg/[[name]] for three [[name]]s without significant improvement. Plasma exchange was not considered because of the pts hemodynamic status. His hospitalization course was complicated by the development of ischemic colitis secondary to dysautonomia, for which he under went subtotal colectomy. The pt expired three weeks after admission from septic shock and acute renal failure. The authors note although the temporal relationship between GBS and influenza vaccination is suggestive of causal relationship, it does not fully prove it.


VAERS ID: 267630 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:2006-10-20
Onset:2006-10-21
   Days after vaccination:1
Submitted: 2006-11-16
   Days after onset:26
Entered: 2006-11-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


VAERS ID: 267810 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: Colorado  
Vaccinated:2006-11-17
Onset:0000-00-00
Submitted: 2006-11-27
Entered: 2006-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB107AC / UNK LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Y0575 / UNK RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR CZ340AA / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR Z0664 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UE913AA / UNK LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravochol 20mg at bedtime
Current Illness: Reported none
Preexisting Conditions: reported none
Allergies:
Diagnostic Lab Data: Unknown, Son reports COD is not yet determined by coroner.
CDC Split Type:

Write-up: Clients son called today to report that client was found deceased in his home this am. His son reported knowing his father received vaccines to go overseas and wanted to make sure Health Department was aware. His son reported that his father had been feeling fine, only had "sore arm" after shots but no other side effects reported. Wife of deceased reported to his son that client was fine this morning. Son was very calm and felt like it would be good to let us know if anything was related. He knows that HD can''t confirm seeing his father. 11/30/06 Received death certificate from coroner. Also received v/m from coroner that no autopsy was performed. COD stated as probable acute myocardial infarction due to atherosclerotic cardiovascular disease & hyperlipidemia per death certificate. 1/2/07 Received medical records from PCP which consisted only of a visit of 8/1/06 for ear wax removal. CXR done 11/13/06 was WNL. WBC 7.9, H/H 16.4/47.5, plts 252. Slightly elevated cholesterol at 163 & low HDL of 34. Globulin elevated at 3.6. PSA 2.37 is WNL. T/C to PCP office to determine is any other visit made in 2006. Stated that patient was scheduled to return to PCP the day after he died & had gotten his labs & CXR in preparation for that visit for a complete PE. Stated that patient was essentially in very good health when last seen in 8/01 & that labs were WNL. Requested that they at least send the most current med list. 1/2/07 Received patients med list which included only Pravachol, Zyrtec D & tetracycline for folliculitis. 1/12/06 Received EKG from PCP. States the only EKG they have was done 11/13/06 & revealed normal sinus rhythm, rate 70.


VAERS ID: 267913 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2006-11-13
Onset:2006-11-27
   Days after vaccination:14
Submitted: 2006-11-28
   Days after onset:1
Entered: 2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2258AA / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NONE


VAERS ID: 268093 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Florida  
Vaccinated:2006-11-29
Onset:2006-11-30
   Days after vaccination:1
Submitted: 2006-12-01
   Days after onset:1
Entered: 2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / UNK LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672C / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Medical Examiner report pending
CDC Split Type:

Write-up: Infant Died within 24 hours of receiving routine child hood immunizations.


VAERS ID: 268248 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Male  
Location: Michigan  
Vaccinated:2006-11-15
Onset:2006-11-26
   Days after vaccination:11
Submitted: 2006-12-04
   Days after onset:8
Entered: 2006-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS 2S601211 / UNK UN / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Pyrexia, Respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glycopyronium bromide, Fexofenadine hydrochloride, Atenolol, Calcium carbonate, Efloraithine, Risedronic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: body temperature 26Nov2006 102 Fahrenheit
CDC Split Type: A0630100A

Write-up: This case was reported by a healthcare professional and described the occurrence of respiratory infection in a 32-year-old male subject who was vaccinated with Influenza virus vaccine trivalent (FluLaval) for prophylaxis. The subject had no pre-existing medical conditions. The subject had received influenza virus vaccine in previous years with no subsequent adverse events. Concurrent medications included Glycopyrronium bromide (Robinul), Fexofenadine hydrochloride (Allegra), Atenolol (Tenormin), Calcium carbonate (Oscal), Eflornithine (Vaniqa) and Risefronic acid (Actonel). On 15 November 2006 the subject received a dose of FluLaval. The reporting healthcare professional follow-up with the subject approximately one week later and the subject had " no side effects to report". On 26 November 2006, 11 days after vaccination with FluLaval, the subject experienced a fever of 102 degrees Fahrenheit and a respiratory infection. On 28 November 2006 the subject was taken to the emergency room. The healthcare professional reported that on 28 November 2006 the subject had "stopped breathing and they (the emergency room) were unable to resuscitate". The subject died on 28 November 2006. It was unknown whether an autopsy was performed.


VAERS ID: 268453 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2006-11-14
Onset:2006-11-15
   Days after vaccination:1
Submitted: 2006-12-06
   Days after onset:21
Entered: 2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS 2F601711 / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Blood pressure decreased, Dysphonia, Dyspnoea, Heart rate increased, Pallor, Pharyngolaryngeal pain, Pneumonia, Renal failure, Respiratory arrest, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-22
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness:
Preexisting Conditions: BRAIN INJURY HIV REPORTED BY MOTHER NO KNOWN ALLERGIES
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MOTHER STATES SYMPTOMS STARTED ON THE 15TH OR 16TH. HE COMPLAINED OF SORE THROAT. MOTHER STATES HE HAD DIFFICULTY BREATHING, HOARSENESS, WHEEZING, PALENESS, WEAKNESS, A FAST HEART BEAT AND DIZZINESS. DENIES HIVES. HE WAS TAKEN TO ER ON 11/19. SHE SAID HIS HEART RATE IN ER WAS 152 AND HIS BP VERY LOW. HE WAS DIAGNOSED WITH PNEUMONIA. HE HAD A RESPIRATORY ARREST AND THEN LATER KIDNEY FAILURE. PARENTS CAME AND REPORTED THIS TO FIRST DISTRICT BECAUSE THE CLINIC HAD TOLD THEM TO. THEY WERE RELUCTANT TO GIVE THEIR ADDRESS AND THEIR NAMES. "WE HAVE BEEN THROUGH ENOUGH." 12/8/06 Received medical records from 1st hospital which reveal patient admitted 11/19/06. Patient had 4 days of sore throat, fever, dry cough & diarrhea. Patient continued to deteriorate, coded & expired on 11/22/06. No autopsy was done. LABS: CXR hazy infiltrates in bilateral lung bases. CT of abdomen & pelvis WNL. US of kidney was WNL. CK 11, 046 & troponin 0.24. Bone marrow biopsy done was WNL. WBC 9.21, plts 99, Na 131, elevated liver enzymes. Final Dx: acute tubular necrosis; chronic renal failure likely secondary to HIV nephropathy; HIV positive; COPD, thrombocytopenia; culture negative sepsis; hypotension; respiratory failure/hypoxia; alcoholism; tobacco abuse; seizures secondary to head trauma; depression; s/p LS operation; hypothyroidism; insomnia; and anxiety. 1/5/07 Received Death Certificate from funeral home which reveals COD as HIV/AIDS with rhabdomyalysis as a contributing factor.


VAERS ID: 268477 (history)  
Form: Version 1.0  
Age: 89.0  
Sex: Male  
Location: Ohio  
Vaccinated:2006-11-07
Onset:0000-00-00
Submitted: 2006-12-03
Entered: 2006-12-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2250AA / UNK RA / -

Administered by: Public       Purchased by: Private
Symptoms: Back pain, Guillain-Barre syndrome, Laboratory test abnormal, Pain, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: As of 5/1/06 over
Current Illness: Spinal stenosis, lubo sacral neuritis.
Preexisting Conditions: Spinal stenosis, lubo sacral neuritis, CHF, Aortic stenosis, Gilberts syndrome, aortic regurgitation, BPH, osteoarthritis, anemia, renal insuffiency.
Allergies:
Diagnostic Lab Data: EMG and Spinal tap confirmed DX according to MD.
CDC Split Type:

Write-up: Reported death due to Guillain Barre Syndrome. Transferred to Hospital on 11/18/06 with severe pain to spinal stenosis, low grade fever, and possible Guillian Barre Syndrome. Dies at hospital. 1/8/07 Received medical records from hospital which reveal patient admitted 11/18/06-11/29/06 for LE pain with ascending paralysis & studies positive for GBS. Treated with IVIG x 4 days. on 11/25, had PEA & coded. Responded well initially then coded several additional times before expiring on 11/29. Consults of pulmonology & neurology included. D/C summary indicates COD as secondary to GBS, causing severe autonomic dysfunction & cardiac arrhythmias. PMH: CHF LABS: EMG/NCS 11/20/06, c/w GBS; CT of head 11/18, showed mild atrophy; fluoroscopic LP on 11/18, revealed elevated protein, normal WBC & RBC. FINAL Dx: Guillain Barre Syndrome; CHF w/ejection fraction of 35%; aspiration pneumonia; BPH; anemia; & CAD. 1/9/07 Received copy of Death Certificate from family which reveals COD as GBS with contributing factors of CAD & spinal stenosis.


VAERS ID: 268521 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Female  
Location: Ohio  
Vaccinated:2006-12-02
Onset:2006-12-02
   Days after vaccination:0
Submitted: 2006-12-02
   Days after onset:0
Entered: 2006-12-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Syncope
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-12-17
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Several
Current Illness: N/A
Preexisting Conditions: Prior history of intracerebral hemorrhage, status post aneurismal surgery PMH: MVA in 1998 in which she experienced a myocardial infarction. CVA followed with a balance disorder. Cerebral aneurysm which was repaired. CHF with an ejection fraction of 35% in 2003. After CVA and aneurysm repair the patient had decrease in peripheral vision and peripheral neuropathy, dysphagia and hyperlipidemia.
Allergies:
Diagnostic Lab Data: MRSA from sputum culture. CXR: cardiomegaly with interstitial edema. CT of head no evidence of acute cortical bleeding. Subsequent CT showering of emboli into the posterior circulation and cerebellar area were noted. EKG: wide QRS complex, left bundle branch block. EEG:record is abnormal and demonstrates generalized disturbances of cerebral functioning manifested by slowing of the background and is compatible with metabolic encephalopathy or other cause of diffuse neural dysfunction.
CDC Split Type:

Write-up: My mother collapsed in the dr office about 10 seconds after the flu shot and went into cardiac arrest. She is currently in ICU. 01/22/07-records received and reviewed. DC DX for DOS 12/02-12/16/06- Acute witnessed cardiopulmonary arrest with resuscitation Ventricular fibrillation Acute respiratory failure Anoxic encephalopathy Prior history of intracerebral hemorrhage, status post aneurismal surgery Methicillin resistant Staphylococcus aureus pneumonia Hypokalemia Cardiomyopathy. HX: Became syncopal and collapsed in physician''s office after receipt of flu vaccine. She immediately came to and was aware of her surrounding. Ambulated to car, as son was driving out of parking lot, patient had a sudden cardiac arrest.. Found to be in ventricular fibrillation and after 4 cardioversions procedures converted into a slow sinus rhythm. Seen in ER required intubation and dopamine drip and dobutamine. PMH: MVA in 1998 in which she experienced a myocardial infarction. CVA followed with a balance disorder. Cerebral aneurysm which was repaired. CHF with an ejection fraction of 35% in 2003. After CVA and aneurysm repair the patient had decrease in peripheral vision and peripheral neuropathy, dysphagia and hyperlipidemia. PE: Did not respond to verbal or painful commands, eye movement was random, at times seemed to have purposeful eye movement but would not move her extremities or reposition her body. Remained obtunded. Ventilator and life support withdrawn. Hospice management. Comfort measures. Transferred to hospice unit. Spoke with hospice unit, patient expired on 12/17/06. 1/25/07 Received Death Certificate which reveals COD as anoxic encephalopathy, cardiopulmonary arrest & CAD.


VAERS ID: 268567 (history)  
Form: Version 1.0  
Age: 0.27  
Sex: Female  
Location: New Hampshire  
Vaccinated:2006-12-07
Onset:2006-12-07
   Days after vaccination:0
Submitted: 2006-12-08
   Days after onset:1
Entered: 2006-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B073AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF025AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08682F / 1 RL / 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: 2006-12-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRN USE OF ALBUTEROL NEBULIZER
Current Illness: RECENTLY RECOVERED FROM BRONCHIOLITS (NEGATIVE RSV TEST) TRACHEOMALACIA STAWBERRY HEMANGIOMA ON LEFT FLANK
Preexisting Conditions: IUGR
Allergies:
Diagnostic Lab Data: RSV test negative on 12/3/2006
CDC Split Type:

Write-up: Apparent SIDS 8 hours post immunizations. 2/5/07 Received autopsy report which states COD as SIDS (category II). Findings at autopsy: unclear if found in bassinet or in infant seat; 36 wks gestation, complicated by preeclampsia; s/p overnight hospitlization 12/3/06 for RSV negative bronchiolitis; s/p multivax on 12/7/06. 03/06/07-received immunization records and family history along with PCP note of adverse event .


VAERS ID: 268705 (history)  
Form: Version 1.0  
Age: 0.19  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2006-12-04
Onset:2006-12-05
   Days after vaccination:1
Submitted: 2006-12-06
   Days after onset:1
Entered: 2006-12-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Coma, Sudden infant death syndrome
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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: 2006-12-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


VAERS ID: 268775 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2006-10-27
Onset:2006-10-27
   Days after vaccination:0
Submitted: 2006-12-01
   Days after onset:35
Entered: 2006-12-12
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS 2F601011 / UNK LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Cerebrovascular accident, Coronary artery disease, Dysarthria, Dyspnoea, Hyperlipidaemia, Hypertension, Myocardial infarction, Orthopnoea, Pain, Transient ischaemic attack, Wheezing
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Other ischaemic heart disease (narrow), Lipodystrophy (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2008-04-15
   Days after onset: 536
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Altace, Topril XL, Lexapro , Hydrochlorothiazide, Dynacric CR, Aspirin
Current Illness:
Preexisting Conditions: She had a stroke and 5 bypass surgery about 7 years ago.
Allergies:
Diagnostic Lab Data: She had a stroke and heart attack. She continued having same types of illnesses for the next 15 months and heart attacks until 4-15-08 when she passed away after having a brain annurism.
CDC Split Type: NC06102

Write-up: Within 4 hours after receiving the vaccine she started having pain and weakness throughout her body. She had a stroke several years ago and 5 by pass heart surgery in 2000. Since her husband has the same symptoms, we thought it was from the flu shot and would soon end, but about 8, 11/09/06 she was taken to hospital by rescue squad. 12/19/06-records received and reviewed. DC Summary: Acute non-ST elevation myocardial infarction. Congestive Heart Failure due to Ischemic left ventricular dysfunction Coronary artery disease with previous coronary artery bypass graft surgery Transient ischemic attack with right arm weakness. Hypertension Hyperlipidemia Status post bilateral carotid endarterectomy and cholescyctectomy. Presented to ER with dyspnea and wheezing, flu vaccine 2 weeks ago and had prolonged viral syndrome that she did not seek treatment for. On day of admission developed 2 episodes of right arm weakness and right facial and tongue weakness with slurred speech and she developed sudden dyspnea, orthopnea and wheezing. 12/1/08-copy of death certificate received-COS multisystemic organ failure. Date of death 4/15/08. Information received on annual follow up: Adverse event unrelated to vaccination. Patient has multiple on going health problems. Date of vaccination was 10/27/06 not 11/3/06 as originally reported.


VAERS ID: 268818 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2006-10-05
Onset:2006-10-05
   Days after vaccination:0
Submitted: 2006-12-05
   Days after onset:61
Entered: 2006-12-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (TDVAX) / MASS. PUB HLTH BIOL LAB TD165 / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Dementia
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-12-16
   Days after onset: 72
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI showed subtle increased DWI signal in occipital poles. low intensity within the cortex of medial aspect of the left frontal and parietal lobes, cortex of lateral aspect of right and parietal lobes on FLAIR and DWI sequences. No definite white matter abnormalities seen and no enhancement. No deep gray matter nuclear abnormalities seen. LP negative. EEG generalized slowing. CSF: 2 WBC, 100% monocytes, 0 RBC, glucose 66, protein 41. Culture negative, opening pressure 15. 2D echocardiogram:mild LVH and mild LAE. CXR negative MRA negative. Rheumatoid factor and ANA negative. US showed 5-10 WBC but culture negative. Chem and CBC normal. Viral culture negative Lyme antibody 0.10 Homocystine level 13.8 and 10.7 on repeat. Vitamin B12 393 and 445 on repeat. ANCA less than 1-20, antithyroglobulin antibodies less than 20.0 and anti-TPO less than 25, anticardiolipin antibodies negative. Anti-DNA antibodies negative, ANA positive with a titer of 1:320 NSP pattern type 2 which is atypical speckled pattern. Four vessel cerebral angiogram no evidence of vasculitis.
CDC Split Type:

Write-up: Rapidly progressive dementia, likely CJD. 01/02/07-records received and reviewed. DC DX for DOS 11/11-11/23/06 DX: rapidly progressive dementia, likely Creutzfeldt-Jakob disease. 30 minutes after receiving tetanus shot she reported roaring sensation in both ears, 2 weeks prior to admission she was evaluated and felt to have eustachian tube dysfunction. She had slowing mentation, blunted affect and confusion. Allergist consults: rapid progressive dementia, although acute/chronic encephalopathy have been prescribed for a subset of vaccinations, not aware of this to be a result from Td vaccination. Per information received from the annual follow up she died Dec. 16th 2006. Follow-up: She died. Doctors did not admit that her affliction was triggered by a vaccine, but she developed symptoms 1/2 hr. after having the shot.


VAERS ID: 268863 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Ohio  
Vaccinated:2006-09-26
Onset:2006-10-18
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2006-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2166AB / UNK RL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Cerebral atrophy
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Congestion
Preexisting Conditions: CP Pontocerebellar atrophy, brain stem atrophy.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child passed away 10/18/06. Patient was chronically ill with pontocerebellar atrophy, had shortened life expectancy 1/11/07 Received medical records from hospital which reveal patient admitted 10/13/06 secondary to cardiopulmonary arrest. Apparently had been in usual state of health & was riding in car w/parent when suddenly became pale with circumoral cyanosis & stopped breathing. Parent initiated rescue breathing & called EMS who then initiated CPR, intubated & gave epi during transport to outlying hospital before transfer to this Hospital. Made DNR & expired on 10/18/06. PMH: undefined degenerative neurologic disorder, feeding tube, salivary gland removal. Hx of previous arrest from respiratory secretions. Had otitis media 10 days prior to admit tx w/antibiotics. Birth HX: Adopted. Normal development till 9 mos of age when lost milestones. Currently, eyes open spontaneously, non verbal, sits only with support. unable to grasp. Joint contractures of all extremities. LABS: MRI revealed hypoxic/ischemic event to putamen/caudate (some new), cerebral atrophy & cerebellar degenerative changes. Trach c/s grew pan susceptible pseudomonas. Blood & urine c/s all neg. WBC 12.8 on admit, max of 26.8 on 10/16. CXR showed LLL density due to atelectasis & collapse. FINAL DX: None provided. 4/6/07 Received Death Certificate which reveals COD as upper airway obstruction; hypoxic ischemic encephalopathy; cerebral atrophy; and neuromuscular disease (unspecified).


VAERS ID: 269004 (history)  
Form: Version 1.0  
Age: 0.19  
Sex: Male  
Location: Virginia  
Vaccinated:2006-12-04
Onset:2006-12-09
   Days after vaccination:5
Submitted: 2006-12-13
   Days after onset:4
Entered: 2006-12-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


VAERS ID: 269005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:2006-12-04
Onset:2006-12-09
   Days after vaccination:5
Submitted: 2006-12-13
   Days after onset:4
Entered: 2006-12-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received Daptacel, Prevnar, and Rotateq on 12/04/06. Twin brother received same shots on the same day. They did not have any adverse symptoms after few days. On 12/19/06, mom fed them at 5am, went to bed, then found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition as simultaneous death of twin brother & tracheitis & bronchitis. Pathological Dx: I. Sudden unexpected infant death A. Twin A infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain, congestion and neuronal heterotopis, mild D. Tracheitis & bronchitis, chronic, mild to mod sever. II. Ancillary studies, other, non-contributory III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


VAERS ID: 269028 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: South Carolina  
Vaccinated:2006-12-07
Onset:2006-12-17
   Days after vaccination:10
Submitted: 2006-12-18
   Days after onset:1
Entered: 2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0402F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt deceased 12/17/2006.


VAERS ID: 269451 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Mississippi  
Vaccinated:2006-12-13
Onset:2006-12-13
   Days after vaccination:0
Submitted: 2006-12-19
   Days after onset:6
Entered: 2006-12-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B064AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0281F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 208657C / 2 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coma
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: dropped at 2 mo of age, sustained CHI w/SAH.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING LABS: CXR showed slight increased density in left upper lobe. Serum studies negative for A985G mutation. Lung c/s (+) for MRSA.
CDC Split Type: MS06020

Write-up: bABY FOUND UNRESPONSIBE ABOUT 11 P.M BY FATHER. dAD CALLED THE MOTHER OF CHILD WHO IS AN ICU NURSE. SHE CALLED AN AMBULANCE. DAD BEGAN CPR. THE CHILD WAS TAKEN TO HOSPITAL AND THEN FLOWN TO MC. THE CHILD LIVED ABOUT 12 HOURS OFF LIFE SUPPORT. 12/21/06 Received medical records from initial hospital which reveals patient arrived at ER in full arrest, had been intubated by EMS in the field & CPR was in progress. Patient had been down approx 20-25 min prior to arrival to ER. During code in ER given multi doses of atropine & epi with no response. Developed V tach & was cardioverted multi times. Finally stabilized after Lido begun & ET tube replacement. Had to be transported to tertiary hospital via ambulance instead of helicopter due to bad weather in the area. 8/17/07 Received Death Certificate from state epidemiologist office which states COD as necrotizing bacterial pneumonia. 2/11/08 Reviewed autopsy report which states COD as necrotizing bacterial pneumonia. Brain revealed slightly thickened & mildly inflamed leptomeninges & early signs of hypoxic-ischemic encephalopathy.


VAERS ID: 269625 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2006-12-18
Entered: 2006-12-27
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Viral infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0612USA01335

Write-up: Information has been received from a consumer concerning an 8 year old patient who may have been vaccinated with a dose of varicella virus vaccine live. Subsequently the patient experienced a mild case of chickenpox and died while recovering from the chickenpox. The exact cause of the patients death was not determined, but local officials say they doubt chickenpox is to blame. Additional information has been requested.


VAERS ID: 269765 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: California  
Vaccinated:2006-03-14
Onset:2006-03-20
   Days after vaccination:6
Submitted: 2006-12-20
   Days after onset:275
Entered: 2006-12-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0846R / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Condition aggravated, Eosinophilia, Haemorrhage, Nervous system disorder, Thrombocytopenia, Vaccine positive rechallenge
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-04-07
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: aplastic anemia and eosinophilia~Hep A (no brand name)~1~2.00~In Patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: Aplastic anemia, stable off meds 11/05
Allergies:
Diagnostic Lab Data: Platelets prior to immunization above 50,000 and eosinophils less than 5%. Five days after Hep A, EOS 47-60% and plt decreased to 8-20,000
CDC Split Type:

Write-up: Recurrent eosinophilia; worsening thrombocytopenia - began to require platelet transfusion, then had CNS bleed


VAERS ID: 269826 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2006-12-20
Onset:2006-12-21
   Days after vaccination:1
Submitted: 2006-12-28
   Days after onset:7
Entered: 2006-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2174KA / 2 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Coma
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: 5/9/08 Had hx of being in same ER on 1/12/06, 2/9/06 & 4/6/06, all for flu like s/s w/acute febrile illness & abdominal pain.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found unresponsive at home and brought to ED - unable to resuscitate; pronounced dead. 5/9/08 Autopsy report states COD as changes c/w viral pneumonia, bilateral & manner of death as natural. Autopsy report states patient arrested while at home & transported to ER.


VAERS ID: 269840 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Female  
Location: Ohio  
Vaccinated:2006-01-30
Onset:0000-00-00
Submitted: 2006-12-29
Entered: 2006-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bacterial infection, Hypotension, Respiratory distress, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Culture from blood isolated Streptococcus pneumoniae. Sensitive to Azithromycin, Moxifloxacin, Tetracycline, Trimeth/Sulfa, Vancomycin. Resistant to Penicillin
CDC Split Type:

Write-up: Admitting diagnosis: respiratory distress, hypotension, UTI.


VAERS ID: 269910 (history)  
Form: Version 1.0  
Age: 1.19  
Sex: Male  
Location: California  
Vaccinated:2006-12-01
Onset:2006-12-12
   Days after vaccination:11
Submitted: 2006-12-22
   Days after onset:10
Entered: 2007-01-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Coma
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


VAERS ID: 269911 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Male  
Location: Illinois  
Vaccinated:2006-11-01
Onset:2006-11-01
   Days after vaccination:0
Submitted: 2006-12-21
   Days after onset:50
Entered: 2007-01-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA215BA / UNK RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Dyspnoea, Emphysema, Feeling cold, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: COPD
Preexisting Conditions: COPD with emphysema.
Allergies:
Diagnostic Lab Data: No autopsy. Death certificate lists 1 cause of death as emphysema per daughter.
CDC Split Type:

Write-up: 90 minutes after receipt of flu vaccine, pt complained of SOB and felt cold. Pt with prior diagnosis of COPD. Refused medical treatment. Took breathing Rx as prescribed for chronic condition. Next day had fever 100.2 F and persistent complaints of SOB. Refused to seek medical treatment. Expired later in day approximately 29 hours after immunization.


VAERS ID: 269930 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2006-10-13
Onset:2006-11-12
   Days after vaccination:30
Submitted: 2007-01-02
   Days after onset:51
Entered: 2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2216AA / UNK LA / IM

Administered by: Public       Purchased by: Public
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: 2006-11-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Diabetes
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11-12-06 Cardiac Arrest 3/26/07 Received Death Certificate which reveals COD as cardiac dysrhythymia & myocardial infarction with contributing factor of diabetes.


VAERS ID: 269984 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-01-02
Entered: 2007-01-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / SC

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:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0612USA03333

Write-up: Information has been received from a healthcare worker concerning a child who on an unspecified date was vaccinated with a dose of vARIVAX vaccine and concomitantly with a dose of MMR II. Subsequently the patient died. There was no product quality complaint involved. Additional information was sought, and the reporting healthcare worker indicated that she heard of this case through a pediatrician who was since retired. The patient was not a patient in the reporters office. She did not know if the patient had actually ever been a patient of the retired pediatrician. No further information was provided. No further information is available.


VAERS ID: 270156 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2006-12-29
Onset:2006-12-31
   Days after vaccination:2
Submitted: 2007-01-08
   Days after onset:8
Entered: 2007-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2176AA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: runny nose, temp 100.5~DTaP (no brand name)~4~1.00~In Patient
Other Medications: Poly Vi Flor drops 0.25 mg
Current Illness:
Preexisting Conditions: PMH: PDA treated with meds; 4 mos premature, 1.5 lbs at birth with normal growth & development now, in 96th percentile.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild clear nasal drainage, slight cough, temp 100.7 2/20/07 Received autopsy report which reveals COD as complications of pneumonitis.


VAERS ID: 270165 (history)  
Form: Version 1.0  
Age: 0.41  
Sex: Male  
Location: Nevada  
Vaccinated:2006-12-22
Onset:2006-12-23
   Days after vaccination:1
Submitted: 2007-01-08
   Days after onset:16
Entered: 2007-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B0740A / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0085F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 57556B / 2 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: born with imperforate anus, had colostomy in place
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexplained death within 24 hours of 4 month vaccines in the office. 3/26/07 Received Autopsy Report which reveals COD as SIDS. Patient had colostomy in place s/p surgical formation of rectum at birth & site was considered unremarkable. Child had been examined by PCP on 12/22/06 & received vax. Found to be well at that time.


VAERS ID: 270289 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Colorado  
Vaccinated:2006-07-31
Onset:2006-08-09
   Days after vaccination:9
Submitted: 2007-01-08
   Days after onset:152
Entered: 2007-01-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1852AA / 1 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Asthenia, Disseminated intravascular coagulation, Dysuria, Ear pain, Encephalitis, Flank pain, Headache, Hypokinesia, Infection, Lethargy, Multi-organ failure, Otitis media, Pyrexia, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-08-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF: HSV DNC PCR not detected. Clarity slightly cloudy, WBC 1545, RBC 32, Glucose 85 and protein 171. Cultures negative. CBC: WBC 18.4, lymph %3.8, granulocyte 91.7, ESR 122, CRP2.5 Chem: glucose 173. CT brain: low density in right thalamus and basal ganglia, extending into the pons and possibly into the right cerebellar hemisphere although this is not certain. The findings are suspicious for edema. There is a slight mass effect on the fourth ventricle and third ventricle as described. No hydrocephalus. CXR: heart size upper limits of normal. EEG:spindle patterns that are nonspecific in etiology. MRI brain evolving edema of thalamus, basal ganglia and brainstem and middle cerebella peduncles bilaterally, acute abnormality involving the deep white matter.
CDC Split Type:

Write-up: First visit PCP office 8/9/06 vomiting, headache and stomach x 1 day. Diagnosis viral syndrome, headache, abdominal pain, medications: none. Seen at medical center ER 8/10/06 earache started on 8/10/06 am. Diagnosis Otitis media. Treatment Auralgan and Zithromax. Seen at medical center ER 8/14/06 abdominal and flank pain, painful urination and vomiting. Morphine given in ER. Seen at medical center ER 8/15/06 lethargic, weak, low grade fever, and unable to get out of bed and walk. Developed these symptoms on 8/15/06. Diagnosis encephalitis. He was transferred to another Hospital. Patient died on 8/21/06. Autopsy revealed acute hemorrhagic leukoencephalitis (Hurst disease), a rare, fulminant form of acute disseminated encephalomyelitis. The cause of death was likely acute disseminated encephalomyelitis secondary to prominent cytokine release prompted from a prior infection, which ultimately let to development of early DIC and multi organ system failure. 01/16/07-records received and reviewed from Med Ctr. ER visits 8/14/06 and 8/16/06. DX on 8/16/06- meningoencephalitis, cerebral edema. 02/09/07-records received and reviewed from another Hospital for DOS 8/15-8/21/06 DC DX: Cerebral edema basal ganglia edema with right sided thalamic edema in a vascular distribution antiphospholipid antibody positive Presented to ER with persistent vomiting times 10 days leading to ataxia and altered mental status. On transfer to another Hospital he was intubated for a Glasgow Coma Score of 8 Hospital course included antimicrobial therapy and steroids. Developed hydrocephalus and an EVD was placed and subsequently lost all cranial nerve function and was noted on hospital day 6 to be breathing only slightly on the ventilator, also had renal insufficiency of unknown etiology with a rising creatinine. Hypertensive episode with bradycardia and expired. Neuro exam: pupils 2mm and nonreactive to light on left side and 3-2mm and nonreactive to light on right side. Doll eye sign negative. No response to deep pain stimulation. Deep tendon reflexes 0-1 plus. Babinski sign negative. Clonus negative. Gag reflex negative. Funduscopic exam shows obvious papillary edema on right side, left eye was unable to be examined due to small size. Intermittent spontaneous movement of right arm. no movement of left arm.


VAERS ID: 270348 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2006-11-04
Onset:2006-11-17
   Days after vaccination:13
Submitted: 2007-01-10
   Days after onset:54
Entered: 2007-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA210AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Fracture, Lethargy, Oral intake reduced, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: 78 y/o in long-term-care facility. Spoke with infectious control nurse, at the facility who states from record that client temp at time of vaccination 98.7.
Preexisting Conditions: Diabetes, immobility-related to previous leg fractures.
Allergies:
Diagnostic Lab Data: 78 year old female with diabetes. Client living in long-term-care facility due to complications from several falls resulting in leg-knee fractures and poor recovery.
CDC Split Type:

Write-up: 78 y/o female who was a resident of a long-term-care facility for 3+ years, rec''d influenza vaccine on 11/4/06. On aprox 11/17/06 patient''s husband stated that the patient became lethargic, refusing food. 11/19/06 patient expired. Patient''s huband stated "she died of dehydration and kidney failure".


VAERS ID: 270886 (history)  
Form: Version 1.0  
Age: 0.19  
Sex: Male  
Location: Kentucky  
Vaccinated:2004-11-24
Onset:2004-11-27
   Days after vaccination:3
Submitted: 2007-01-11
   Days after onset:775
Entered: 2007-01-22
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A001AA / UNK LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1251N / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A57560H / UNK RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2004-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Slight cough, previous diarrhea, oral moniliasis.
Preexisting Conditions: No Known Allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Sleeping with caregiver. Found not breathing. Vaccines administered within 28 days.


VAERS ID: 271299 (history)  
Form: Version 1.0  
Age: 0.68  
Sex: Female  
Location: Michigan  
Vaccinated:2007-01-24
Onset:2007-01-26
   Days after vaccination:2
Submitted: 2007-01-26
   Days after onset:0
Entered: 2007-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2200KA / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: History of mild left facial paralysis at birth - resolved
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found dead at home 1/26/07. 5/1/07 Received Autopsy Report which reveals COD as probable SIDS.


VAERS ID: 271331 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Male  
Location: Kansas  
Vaccinated:2006-12-04
Onset:0000-00-00
Submitted: 2007-01-26
Entered: 2007-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB068AA / UNK RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / UNK LA / SC
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR Z0663 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denied illness
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I read the patient''s obituary in the newspaper, please refer to primary care physician for more details. I never received any call regarding any adverse event regarding actual vaccines.


VAERS ID: 271346 (history)  
Form: Version 1.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:1998-09-09
Onset:2000-06-15
   Days after vaccination:645
Submitted: 2007-01-27
   Days after onset:2417
Entered: 2007-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV017 / 4 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Amyotrophic lateral sclerosis, Eye pain, Fatigue, Headache, Irritable bowel syndrome, Malaise, Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad), Glaucoma (broad), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-03-16
   Days after onset: 2100
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: sinus problems, mild anxiety issues
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the anthrax vaccine, my husband''s health begin to decline. He had symptons such as fatigue, headaches, eye-aches, IBS, and muscle twitching. He was finally diagnosed with ALS in 2005. He died March 2006. He was vaccinated with Lot # FAV017. There is no history of ALS in his family.


VAERS ID: 271451 (history)  
Form: Version 1.0  
Age: 0.16  
Sex: Male  
Location: Texas  
Vaccinated:2007-01-10
Onset:2007-01-11
   Days after vaccination:1
Submitted: 2007-01-29
   Days after onset:18
Entered: 2007-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / UNK RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08682 / UNK LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / UNK MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Autopsy
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Medical Examiner autopsy.
CDC Split Type: WAES0701USA0482

Write-up: Hospital Infection Control/Risk Management Nurse called clinic to advise patient died in ER and parents think the shots were the cause. Body was sent to Medical Examiner. 3/15/07 Received autopsy Report which reveals COD as SIDS while cosleeping w/adults. Manner of death is undetermined.


VAERS ID: 271530 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Louisiana  
Vaccinated:2007-01-22
Onset:2007-01-22
   Days after vaccination:0
Submitted: 2007-01-23
   Days after onset:1
Entered: 2007-01-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 3 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649H / 3 RL / -

Administered by: Other       Purchased by: Public
Symptoms: Crying, Dyspnoea, Electrocardiogram, Heart rate irregular, Hypoventilation, Laboratory test, Lethargy, Respiratory rate increased, Unresponsive to stimuli, Ventricular hypertrophy, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol at 08:00
Current Illness: None
Preexisting Conditions: Astrait, Viral syndrome, early age.
Allergies:
Diagnostic Lab Data: EKG, CXR, Labwork LABS: CXR showed cardiomegaly & clear lungs. WBC 12.6 K/uL, H/H 9.9/31.2 g/dL. EKG revealed atrial fib-flutter w/multifocal PVCs & LVH. Extensive ST-T changes due to LVH & suggestive of MI. Runs of non-sustained v-tach.
CDC Split Type: LA070101

Write-up: 6 month old into ER, via aunts arms gasping for breath then becoming unresponsive approximately 15 minutes prior to arrival. On admit to ER, patient lethargic with slow shallow respiration weak, crying effort, reported vomiting at home. EKG reported ventricular hypertrophy, rapid irregular rate with PVCS. Patient transferred to a location. Patient coded/died in route to hospital. 2/8/07 Received medical records from hospital which reveal patient brought to ER on 1/22/07 day of vax after experiencing vomiting, SOB then becoming unresponsive w/eyes rolling back in head. Patient was lethargic w/shallow slow breathing & weak cry on admit to ER. Patient transferred to higher level care hospital but expired en route. 6/15/07 Received Autopsy Report which reveal COD as: Changes consistent w/vaccination related death. Pathologic findings: cerebral encephalopathy; thymic enlargement; & visceral congestion. Manner of death: consistent w/accidental.


VAERS ID: 271683 (history)  
Form: Version 1.0  
Age: 1.21  
Sex: Male  
Location: Indiana  
Vaccinated:2007-01-26
Onset:2007-01-28
   Days after vaccination:2
Submitted: 2007-01-29
   Days after onset:1
Entered: 2007-02-05
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2292AA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1203F / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 308682D / 3 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen, previously Pedicare
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Seen on 1/26/07 and received ProQuad, Prevnar, and Flu vaccine. According to grandmother died on Sunday. 4/17/2007 Received Autopsy Report which reveals COD as sepsis with bronchopneumonia & tracheobronchitis. Anatomic findings include: small abrasions on central forehead; marked congestion & edema of bilat lungs; enlarged heart; small contusion on right forhead; skin lesions around mouth & nares & dried mucous around nares.


VAERS ID: 271797 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2006-10-31
Onset:2006-11-03
   Days after vaccination:3
Submitted: 2007-01-30
   Days after onset:88
Entered: 2007-02-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Computerised tomogram, Intubation, Tracheostomy, Vaccination failure, Vocal cord paralysis
SMQs:, Angioedema (broad), Lack of efficacy/effect (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Respiratory failure (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-01-23
   Days after onset: 81
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 50 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Digoxin, Atenolol, Tylenol, Nexium, Coumadin
Current Illness: Compression fraction - lower lumbar
Preexisting Conditions: Rheumatoid arthritis, lung disease, congestive heart failure PMH: MI, atrial fib, defibrillation, HTN, GERD, hiatal hernia, severe rheumatoid arthritis, losteoporosis, umbar compression fx, severe kyphoscoliosis w/restrictive lung disease, constipation, COPD, pulmonary fibrosis, bronchiectasis, SIADH, recurrent aspiration, sleep apnea, chronic anemia, hyponatremia.
Allergies:
Diagnostic Lab Data: CT scan - Bilateral vocal cords not due to stroke or tumor.
CDC Split Type:

Write-up: Three days after Influenza vaccine, my mom''s vocal cords were both paralyzed. She had to be intubated and given a tracheostomy. She never recovered. 2/12/07 Received medical records from hospital which reveal patient experienced SOB & abdominal pain on 11/2/06. ENT consult revealed fixed vocal cords & required emergency entubation then tracheostomy. G-tube placed for nutrition. Throughout hospitalization, had intermittent a-fib & nonsustained v-tach. Patient was noted to be depressed & was evaluated by psych. Pt was transferred to SNF unit for rehab. 2/15/07 Received Death Certificate from daughter which reveals COD as cardiopulmonary arrest; COPD; & CAD.


VAERS ID: 271798 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Georgia  
Vaccinated:2007-01-10
Onset:2007-01-13
   Days after vaccination:3
Submitted: 2007-01-31
   Days after onset:18
Entered: 2007-02-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0268F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dead on Arrival at ER. 2/8/07 Received Autopsy Report which reveals COD as SIDS. Patient was found in prone position on sofa where she slept w/adult so overlay could not be excluded.


VAERS ID: 271962 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Female  
Location: New Jersey  
Vaccinated:2007-01-29
Onset:2007-01-30
   Days after vaccination:1
Submitted: 2007-02-05
   Days after onset:6
Entered: 2007-02-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR Z1038 / 2 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0326 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672K / 2 RL / -

Administered by: Private       Purchased by: Private
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient has no known allergies, birth defects, or other medical conditions. The patient weighed 4 pounds 11 ounces at birth and has a twin sister. Reportedly, the patient had no other concurrent illnesses, but had been diagnosed with "URI" (upper respiratory infection) and diarrhea on 22 January 2007, and was being treated with Rondec DM, nystatin, and "Tylenol products", at the time of the vaccinations on 29 January 2007.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200700303

Write-up: Initial report received on 30 January 2007 from a health care professional. A five-month-old female patient, who was diagnosed with an "URI" (upper respiratory infection) and diarrhea on 22 January 2007, and was being treated with Rondec DM, nystatin, and "Tylenol products", had received, on 29 January 2007 at 16:00 pm, a second, right leg dose of ActHib, lot number UF085AA (lot number Z1038-2), a second, left leg, intramuscular injection of Daptacel, lot number C2553AA, a second, left leg of IPOL, lot number Z0326-2, and a second, right leg dose of Prevnar (manufacturer reported), lot number B08672K. The route of administration was not reported for the ActHib, IPOL, and Prevnar vaccines. The patient''s pediatrician''s office was notified by the coroner that the patient had been found dead by the father sometime in the morning, on January 2007. The patient had no history of birth defects or known allergies. She weighed 4 pounds 11 ounces at birth and has a twin sister. Reportedly, the patient had no adverse events with prior vaccinations. She received her last immunizations (vaccine not provided) on 27 November 2006. No other information surrounding the death was available at the time of this report. 4/7/07 Received Autopsy Report which reveals COD as SIDS.


VAERS ID: 272008 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Michigan  
Vaccinated:2006-08-28
Onset:2006-09-11
   Days after vaccination:14
Submitted: 2007-02-08
   Days after onset:150
Entered: 2007-02-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0812F / 1 UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086S2K / 4 UN / -

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Peripheral coldness, Pyrexia, Rash, Viral myocarditis, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-09-16
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Gastroenteritis & febrile illness for several days prior to death.
Allergies:
Diagnostic Lab Data: body temperature 09/11/06 Fever - for 5 days
CDC Split Type: WAES0702USA00409

Write-up: Information has been received from a physician concerning a 12-month-old female with no pre-existing allergies, birth defects, or medical conditions who on 28-AUG-2006 was vaccinated in the right leg with her first dose of ProQuad vaccine (upgrade process) (lot#654471/0821F). Concomitant therapy that day included Prevnar vaccine (lot# B086S2K). There was no illness at the time of vaccination. There were no adverse reports following prior vaccinations for the patient or siblings. On 11-SEP-2006, the patient developed a fever which lasted for five days and vomited three times. It was reported that the patient developed a three elevated molluscum rashes on the left deltoid and shoulder. The patient turned blue with cold mouth, feet, and hands, and was rushed to the emergency room. On 16-SEP-2006, the patient was pronounced dead. An autopsy was performed and the cause of death was viral myocarditis (life threatening). Additional information has been requested. 2/20/07 Received medical records & autopsy report from provider which reveal patient experienced few molluscum lesions & viral macules on day of vax but was otherwise well. Seen on 9/16 for fever, rash, vomiting & ear pain for approx 5 days. Dx w/gastroenteritis & tx symptomatically. Autopsy Report reveals COD as myocarditis, most likely viral; however, micro studies did not detect virus. It was felt that the molluscum contagiosum rash was not related to the myocarditis. 3/20/07 Received cardiac path report which reveals lymphocytic myocarditis. No congenital anomalies or structural damage noted.


VAERS ID: 272141 (history)  
Form: Version 1.0  
Age: 0.31  
Sex: Male  
Location: New Hampshire  
Vaccinated:2007-01-18
Onset:2007-01-25
   Days after vaccination:7
Submitted: 2007-02-12
   Days after onset:18
Entered: 2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 2 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS UF025AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691B / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-01-25
   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 known~ ()~~0.00~Patient|None known~ ()~~0.00~Sibling
Other Medications: None known
Current Illness: None known
Preexisting Conditions: Mild hydrocephalus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child found dead in crib 7 days after receiving vaccines. Parents report no symptom prior to death. 3/22/07 Received Autopsy Report which reveals COD as SIDS. Manner of death as natural. Findings at autopsy: moderate hydrocephalus & aqueductal stenosis.


VAERS ID: 272228 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: California  
Vaccinated:2007-02-13
Onset:2007-02-14
   Days after vaccination:1
Submitted: 2007-02-14
   Days after onset:0
Entered: 2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146P / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Pt had hydrocephalus at birth
Preexisting Conditions: As noted in 18
Allergies:
Diagnostic Lab Data: Autopsy is planned
CDC Split Type:

Write-up: Pt was found dead of unknown cause the morning after immuns were given. Child was sleeping in bed with mom. 4/20/07 Received Autopsy Report which reveals COD as asphyxia, cannot exclude parental overlay. Patient found face doen position after co-sleeping w/parents. Final dx also included dilation of left renal pelvis.


VAERS ID: 272363 (history)  
Form: Version 1.0  
Age: 0.15  
Sex: Female  
Location: West Virginia  
Vaccinated:2006-11-28
Onset:2006-12-09
   Days after vaccination:11
Submitted: 2007-02-15
   Days after onset:68
Entered: 2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B064AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0719R / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Gastrointestinal necrosis, Septic shock
SMQs:, Toxic-septic shock conditions (narrow), Ischaemic colitis (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-12-09
   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:
Other Medications: Synagis 11/21/06, poly-vi-sol with iron, prophylactic amoxicillin
Current Illness: ,
Preexisting Conditions: prematurity, non surgical necrotizing enterocolitis, bilateralhydronephrosis, hx of Klebsiella UTI and sepsis, omphalocele (unrepaired, ambiguous genitalia PMH: 33 wk preemie, birth wt 2 lbs 15 oz. Omphalocele, necrotizing enterocolitis, PDA, bilat hydronephrosis, recurrent UTIs, Klebsiella sepsis, ambiguous genitalia. In NICU for 50 days, d/c to home on 11/22/06 w/home health nurses. Pregnancy complicated by HTN, IDDM & asthma in mother.
Allergies:
Diagnostic Lab Data: LABS: initial ABG revealed pH 6.77, pCO2 72. K 7.1. Severe anemia.
CDC Split Type: WAES0702USA03738

Write-up: Pt with history of prematurity, non surgical necrotizing enterocoloitis and omphalocele. Recieved routine 2 month immunizations - Pediarx, Hib, Prevnar and Rotateq on 11/28/06. On 12/9/06 presented to ER isseptic shock secondary to necrotic bowel. Patient dies. 2/16/07 Received medical records from reporter/provider which reveal patient was in usual state of health on day of vax. Complicated PMH, see below. Seen next on 12/5 for parental concern re pallor. Afebrile, fussy, + weight gain, abdomen was mildly tympanic but soft w/+BS. Return for vs on 12/7 & parents reported patient had improved at home, no further pallor episodes. temp stable, good appetite, no vomiting. Had seen peds surgeon that day for f/u on omphalocele. Next scheduled visit was for 12/21. 2/16/07 Received Death Summary & Autopsy Report from reporter/provider which reveals on 12/9/06 patient experienced pallor, spitting up since afternoon of admit, fussy, irritable. Exam in ER revealed rectal temp of 91.7, mottled skin, shallow breathing & in acute distress. Had extremely rigid abdomen w/no bowel sounds. Developed cardiac arrhythmias & seizures. Transfused w/PRBCs. Then omphalocele ruptured & had significant bleeding, continuing arrhythmias & finally asystole with unsuccessful resuscitation effort. Autopsy Report reveals probable COD is multisystem organ failure from septic shock secondary to ischemic small intestine within an unresolved omphalocele.


VAERS ID: 272371 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:2007-02-08
Onset:2007-02-10
   Days after vaccination:2
Submitted: 2007-02-15
   Days after onset:5
Entered: 2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Infant Tylenol, Normal saline nose drops
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found in bed unresponsive Saturday morning, Feb. 10, 2007. 3/1/07 Received autopsy report via email from CME office which reveals COD as SIDS. Co-sleeping in full size bed w/parents.


VAERS ID: 272729 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-02-19
Entered: 2007-02-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Death, Haemophilus infection, Meningitis, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0702USA02786

Write-up: It was reported in a published article, title as stated above that 1 child experienced true vaccination failure and developed invasive Hib disease, also referred to as meningitis, despite vaccination with doses of PedvaxHib. (manufacturer unknown). It was reported that the patient experience death, cause unspecified. No further information was available at the time of this report. No outcome information was reported. Upon internal review, invasive Hib disease was determined to be an other important medical event. Additional information has been requested.


VAERS ID: 272731 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-02-19
Entered: 2007-02-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Haemophilus infection, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0702USA02793

Write-up: It was reported in a published article, that 2 children developed invasive Hib disease, after being partially immunized with a median of 1 dose of PedvaxHib (OMPC) (manufacturer unknown) (range 1-2 doses). It was reported that 2 infants died because of nontypeable H influenzae invasive disease. No further information was available at the time of this report. Upon internal review, invasive Hib disease was determined to be an other important medical event. Additional information has been requested.


VAERS ID: 272859 (history)  
Form: Version 1.0  
Age: 0.47  
Sex: Male  
Location: Arizona  
Vaccinated:2007-02-21
Onset:2007-02-21
   Days after vaccination:0
Submitted: 2007-02-21
   Days after onset:0
Entered: 2007-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0403F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08675H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0600F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: infant of diabetic mother, other minor conditions (neonatal jaundice, sinusitis) resolved in timely fashion.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was in apparently vigorous good health and died suddenly within a few hours after leaving clinic visit at which immunizations were administered. 4/13/07 Received autopsy report which reveals COD as SIDS as manner of death as undetermined.


VAERS ID: 272947 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Massachusetts  
Vaccinated:2007-01-11
Onset:2007-02-01
   Days after vaccination:21
Submitted: 2007-02-22
   Days after onset:21
Entered: 2007-02-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2180744A / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF00AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08B25A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Death, Volvulus
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-02-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0702USA03153

Write-up: Information has been received from a physician concerning a 3 month old female who, "five weeks ago," on approximately 11-JAN-2007, was vaccinated with a first 2ml oral dose of ROTATEQ. In the "first week of February," on approximately 01-FEB-2007, the patient died of volvulus. At the time of the report the physician was still awaiting the autopsy report. Unspecified medical attention was sought. No product quality complaint was involved. The patient''s experience was considered to be immediately life-threatening by the reporter. Additional information is not expected. 2/27/07 Received t/c from ME office with prelim COD: 1. Infarct of a major portion of the small intestine. 2. Obstruction by congenital fibrous band. Manner of death was natural. 6/5/07 Received Autopsy Report which reveals COD as infarct, major part of small intestine due to congenital obstructing fibrous band, 28 cm distal to the pylorus and 3 cm proximal to the ileocecal valve; and transmural hemorrhagic ischemis changes throughout the obstructed small bowel. 7/10/07-vac rec received.


VAERS ID: 272954 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Unknown  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2007-02-12
Submitted: 2007-02-20
   Days after onset:8
Entered: 2007-02-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Influenza, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had unspecified underlying health problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200700441

Write-up: Initial report received on 14 February 2007 from a health care provider who has acquired the information from a newspaper article. Per the newspaper article, it has been reported by the state department of health that an eight year old child, who had received a flu vaccination and had unspecified underlying health problems, died from the disease influenza on 12 February 2007. Additional information was not provided related to this case. (The firefighter that was also reported in the title of the article had not been vaccinated.


VAERS ID: 273384 (history)  
Form: Version 1.0  
Age: 1.24  
Sex: Male  
Location: California  
Vaccinated:2007-01-24
Onset:2007-02-11
   Days after vaccination:18
Submitted: 2007-03-02
   Days after onset:19
Entered: 2007-03-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2552AA / UNK UN / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0257F / UNK UN / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1396F / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Autopsy, Death, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-02-12
   Days after onset: 1
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Jaundice neonatal PMH: NSVD, phototherapy for hyperbilirubinemia. URI s/s for 2-3 wks prior to admit.
Allergies:
Diagnostic Lab Data: computed axial 02/11?/07 - Non-conclusive LABS: from outlying ER, WBC 10.3, neutros 48, bands 4, lymphs 39. CT of brain, abdomen & pelvis were WNL. Blood c/s, urine c/s & RSV were all pending. Urine tox neg. LFTs were WNL. CSF showed 0 WBC & RBC, protein 155, glucose 70. EEG was severely abnormal w/evidence of slowing but no seizure activity. Rapid influenza was neg. Repeat CT scan showed no edema but extensive deep white matter abnormalities, probably congenital in origin, mitocondrial antibody type disorder was suspected as not typical of neoplastic or inflammatory process. MRI was recommended but due to continued deterioration was not able to be performed. Cerebral perfusion scan showed no blood flow.
CDC Split Type: WAES0702USA03955

Write-up: Information has been received from a physician concerning a 15-month-old male with a history of jaundice at birth, who on 24-JAN-2007 was vaccinated with a 0.5ml dose of ProQuad (lot #656160/1396F, expiration date 16-MAY-2008). Concomitant vaccinations included: Prevnar (lot #B08639A), Tripedia (lot # C2552AA) and Comvax (lot reported as 653660/0257F). Subsequently, on 11-FEB-2007 the patient experienced a mental state change and was hospitalized. The patient underwent a CT scan that was non conclusive at the time of this report. It was reported that the patient experienced unexpected rapid deterioration and died on 12-FBE-2007. An autopsy was performed, however, results were not yet available. The cause of death was unknown at the time of this report. The patients adverse experiences were considered to be life threatening and disabling. Additional information has been requested. 4/24/07 Received medical records from PCP which reveal patient experienced good health on day of vax. Later on day of vax developed swollen left leg & patient had difficulty walking that day. Next day was resolved when seen by PCP. Dx suspected Prevnar reaction. On 1/26 seen in ER for abdominal distention, vomiting & diarrhea. ER dx w/ileus. Seen by PCP 1/27 & dx w/resolving ileus secondary to acute gastroenteritis. Next note is of t/c from parent that patient deceased on 2/12/07. PCP requested autopsy report on 2/28/07. Vax record included w/med records from PCP. 4/24/07 PCP also forwarded med records from 2/12/07 hospitalization which reveal patient experienced altered mental status, fussiness, congestion, swollen face, increased sleepiness & pallor. Patient had been seen at outying Urgent Care center then transported to outlying ER via ambulance for fever, wheezes & respiratory difficulty w/a single apneic period reported. Child then transported to another hospital for PICU higher level of care. On admit there, very lethargic, pale, crying & opening eyes intermittently. There was crusty nares, inspiratory wheezing & crackles & coarse breath sounds, no neck rigidity, hypotonia. Started on antibiotics & LP obtained. Seizures were noted in PICU & loaded w/dilantin. Emergently intubated following AM for dilated pupils, responsiveness to deep pain w/decerebrate posturing & respiratory difficulty. Treated w/high dose steroids for possible ADEM. Condition deteriorated over the day, patient declared brain dead & deceased. ER DX: meningitis vs encephalitis. PICU Dx: brain stem dysfunction. 10/2/07 Reviewed Autopsy Report which revals COD as undetermined & manner of death as undetermined.


VAERS ID: 273434 (history)  
Form: Version 1.0  
Age: 0.01  
Sex: Male  
Location: New Hampshire  
Vaccinated:2006-07-02
Onset:2006-08-09
   Days after vaccination:38
Submitted: 2007-03-05
   Days after onset:208
Entered: 2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB256AA / 1 - / -

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: 2006-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH0704

Write-up: Undetermined category II SIDS. 3/20/07 Received Autopsy Report which reveals COD as Undertermined (Category II SIDS). Following were findings at Autopsy: hx of recent cough hx of cosleeping w/parent bloody fluid about nasal orifices pulmonary congestion & edema No evidence of trauma, natural disease, toxicological findings or metabolic disorder. Patent ductus arteriosus. Meckels diverticulum.


VAERS ID: 273879 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:2007-02-06
Onset:2007-02-14
   Days after vaccination:8
Submitted: 2007-03-02
   Days after onset:16
Entered: 2007-03-13
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE992AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure, Brain death, Cyanosis, Death, Infection, Life support, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Infant found in crib not breathing and cyanotic, parent began CPR and call 911. Child placed on life support and later declared brain dead. Taken off life support and pronounced dead. Child treated with various medication for infection , blood pressure. 7/20/07 Received Autopsy Report which reveals COD as unexplained sudden death; ischemic brain injury & diffuse cerebral edema; coagulopathy; metabolic acidosis; & stool positive for rotavirus (possible false (+) secondary to vax 5 days prior. Patient had undergone organ retrieval & autopsy was limited to lungs, uterus, ovaries, trachea, esophagus, distal colon & brain.


VAERS ID: 273981 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:2007-03-02
Onset:2007-03-02
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:11
Entered: 2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypotonia, Intubation, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am a pediatrician and was paged to ER to help with a 2month old coding. Mom said pt had received his vaccines then on the way home had stopped breathing so mom stopped the car then saw and ambulance. Paramedics found pt limp and brought him to Kaiser ER. When I saw pt., he was already intubated and had received epinephrine, bolus. Pt was coded for about 40-45 minutes and pulse never returned. I don''t know where pt was vaccinated and I don''t have any information on the vaccines given. 5/18/07 Received autopsy report which reveals COD as congenital heart disease (tetralogy of Fallot). Findings at autopsy include: I. Congenital cardiac malformation (tetralogy of Fallot) A. globular appearance to heart B. malposition of great vessels w/an "overriding aorta" C. mild subpulmonic valve stenosis D. High membranous VSD E. Right ventricular hypertrophy 1. pulmonary HTN 2. diffuse pulmonary congestion F. Large atrial septal defect G. left superior vena cava that emties into coronary sinus H. Juxtaposition of atrial appendages w/both atrial appendages lying on left side of great vessels. I. Right sided aortic arch J. Bilateral pleural serosanguineous effusions K. Peritoneal serosanguineous II. Horseshoe kidney III. Postmortem blood toxicology A. Acetaminophen 4.2 mg/L. IV. Postmortem metabolic profile unremarkable.


VAERS ID: 273989 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-03-14
Entered: 2007-03-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Death, Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK PMH: COPD; breast cancer w/right mastectomy, nonrecurrent; hyperlipidemia; paroxysmal atrial fibrillation converted w/cardioversion; s/p throidectomy for nodule; pulmonary HTN; systemic HTN; current cigarette abuse; ETOH use; pulmonary nodule; carotid arterial disease s/p left carotid endarterectomy; mitral valve insufficiency; osteoporosis; peripheral edema; panic disorder; cellulitis of left leg; chronic back pain w/sciatica; and osteoarthritis.
Allergies:
Diagnostic Lab Data: UNK LABS from PCP: 1/31/07 ck elevated at 159; HDL elevated at 63, LDL elevated at 108, triglycerides elevated at 162. LS spine series o 12/06 revealed DDD, muscle spasm & atheroscerotic vascular dx w/prior renal artery stent placement. LABS from hospital 2/20/07: CXR revealed right pleural effusion & RLL pneumonia. WBC 18,000 w/left shift; H/H 11.9/33.1, creatinine 1.5, Na 130 EKG revealed left anterior hemiblock & complete right BBB w/degree of interventricular conduction delay. Blood, sputum & urine c/s done, results not reported.
CDC Split Type: WAES0703USA01404

Write-up: Information has been received from a physician concerning an 83 year old female who "within the last six months," in approximately 2007, was vaccinated with a dose of Zostavax. Subsequently the patient developed shingles. It was also reported that the patient was deceased from causes unrelated to the experience with Zostervax. Additional information has been requested. 3/22/07 Received Death Certificate which reveals COD as sepsis, right lower lobe pneumonia with contributing conditions of COPD & s/p right mastectomy for breast cancer. 6/8/07 Received medical records from PCP which included hospital records from 2/20-2/23/07 hospitalization after patient experienced SOB, nonproductive cough, chest pain, fever & chills, decreased appetitem malaise & weakness w/multiple falls while home. Family brought to ER & dx w/pneumonia. Admitted to ICU due to episode of hypotension & started on IV antibiotics. Respiratory status declined, developed respiratory acidosis & was intubated. Consult w/pulmonology & cardiology. Renal function then declined. Consult w/nephrology. Continued to decline, developed atrial fibrillation & arrested. Resuscitation efforts were unsuccessful & patient was pronounced. FINAL DX: Sepsis due to RLL pneumonia; respiratory failure due to sepsis & RLL pneumonia. PCP office visit of 11/15/06 notes that patient had recently received Zosavax & now had faint eruption of shingles. Tx w/Valtrex at that time. 2/2/07 office visit notes post herpes polyneuropathy tx w/cymbalta & lyrica.


VAERS ID: 274046 (history)  
Form: Version 1.0  
Age: 0.11  
Sex: Male  
Location: California  
Vaccinated:2007-03-12
Onset:2007-03-13
   Days after vaccination:1
Submitted: 2007-03-15
   Days after onset:2
Entered: 2007-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE880AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649C / 1 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Autopsy, Body temperature increased, Death
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Very mild URI- stuffy nose only
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None. Autopsy in progress
CDC Split Type:

Write-up: Baby found dead in crib less than 24 hours after vaccine administered. Had minimal temp to 100F prior to being put down to bed at 2 AM was found dead at 8 am. 08/21/07 Received autopsy report which states COD as SIDS & co-sleeping w/parents. Tox screen neg except for therapeutic amount of acetaminophen.


VAERS ID: 275428 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2007-03-01
Onset:2007-03-07
   Days after vaccination:6
Submitted: 2007-04-02
   Days after onset:25
Entered: 2007-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0943R / 2 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autopsy, Myocarditis, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-03-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: aortic and mitral valve insufficiency, unknown aetiology
Allergies:
Diagnostic Lab Data: ER LABS of 3/8/07: ABG pH 7.23, po2 62. Serum glucose 353, Creat 1.7, albumin 2.6, total protein 4.9, SGPT 62, SGOT 359. Blood c/s was neg. 2005 Cardiology LABS: echocardiogram revealed mild mitral valve & aortic valve insufficiency. Mitral valve leaflets were slightly thickened.
CDC Split Type:

Write-up: presented to ED with Ventricular tachycardia. Preliminary autopsy finding of myocarditis. 4/3/07 Spoke w/ME who stated prelim COD as acute myocarditis, presumably viral. States patient had PMH of heart murmur which was evaluated by ped cardiologist who found mild aortic & mitral valve insufficiency & regurgitation. ME states did not see evidence of that on autopsy but did find cardiomegaly. Also states patient had been taken to ER on day of death for abdominal pain w/fever & was dx w/gastroenteritis. CXR at that time revealed cardiomegaly. No EKG or cultures were done. Was d/c to home & continued to not feel well. Parent found patient in bathroom unresponsive at approx 2AM & was transported to a second ER where she expired. ME states patient had approx 2 week hx of cough & runny nose prior to death. 6/12/07 Received final Autopsy Report which reveals COD as acute probable viral etiology myocarditis & manner of death as natural. 6/29/07 Received ER records from hospital where patient expired which reveal patient was in respiratory arrest & had been intubated by EMS. ACLS measures were unsuccessful & patient pronounced. 8/24/07 Received cardiology consult which reveals patient evaluated for heart murmur in 2005 which had been diagnosed for long time but never evaluated. Patient admitted to palpitations & nervousness. Patient history did not reveal any evidence of rheumatic fever. Antibiotic endocarditis prophylaxis recommended prior to dental & surgical procedures. Patient was to f/u w/cardiology in 2-3 yearrs to document progress of valvular insufficiency. FINAL Cardiology DX: Aortic & mitral valve insufficiency of unknown etiology.


VAERS ID: 275438 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2007-03-12
Onset:2007-03-26
   Days after vaccination:14
Submitted: 2007-04-02
   Days after onset:7
Entered: 2007-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yasmin birth control pills; hormal contraceptives
Current Illness: None
Preexisting Conditions: None PMH: contraception; Non-smoker
Allergies:
Diagnostic Lab Data: echocardiogram, 03/26?/07, very enlarged right ventricle and small left ventricle as well as large blood clots (see narrative)
CDC Split Type: WAES0705USA05011

Write-up: Given Gardasil vaccine dose #1 3/12/07. No adverse reaction reported. Collapsed and died on 3/26/07 secondary emboli (records unavailable). 4/3/07 Spoke w/investigating deputy who stated autopsy done at Medical Center. T/C to physician at Medical Center who is actually a cardiologist, not pathologist, who had responded to the code & pronounced. Spoke w/secretary who states from Death Certificate COD is sudden cardiac death and pulmonary embolism. Echocardiogram revealed very enlarged right ventricle & small left ventricle as well as large blood clots within both the right atrium & right ventricle. 6/25/07 Received Autopsy Report which reveals following anatomic diagnosis: 1. Pulmonary embolism, occlusive a. pulmonary trunk, left hilar & peripheral vessels b. acute cor pulmonale (by echocardiogram) 2. Pulmonary congestion & edema, bilatera a. no evidence of anomalous coronary artery distribution b. no evidence of ventricular dysplasia This is in follow-up to report(s) previously submitted on 6/11/2007. Information has been received on request from the FDA under the Freedom of Information Act and from a physician who presented at the "Global Advisory Committee on Vaccine Safety World Health Organizaqtion" concerning a 19 year female nonsmoker with no history who on 12-MAR-2007 was vaccinated IM into the left arm with a first dose of GARDASIL lot #655849/0263U). Concomitant therapy included oral contraceptives. There was no adverse reaction reported. Subsequently on 26-MAR-2007 the patient, while exercising on a field collapsed, began convulsing and died secondary to emboli. An autopsy was done and on the death certificate the following is documented "sudden cardiac death and pulmonary embolisem." An Echocardiogram revealed a very enlarged right ventricle and small left ventricle as well as large blood clots within both the right atrium and right ventricle. Coronary artery thrombosis and thrombosis were alsor reported. Upon internal review convulsing was considered an other important medical event. The original reporting source was not provided. A standar lot check investigation was performed. All in-process quality checks for the lot number in question were satisfactory. In addition, an expaned lot check investigation was performed. The testing performed on the batch prior to release met all release specifications. The lot met the requirements of the Center for Biologics Evaluation and Research and was released. No further information is available. This report was filed with the FDA. The VAERS number is 275438.


VAERS ID: 275756 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:2007-04-04
Onset:2007-04-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0403F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649F / 1 RL / IM

Administered by: Private       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Had Bronchiolitis on 3-20-07 PMH: f/t vaginal birth complicated by breathing problems which required hospital stay beyond mother. Since birth 1 episode of bronchiolitis, resolved. Fever 2 days prior to death but resolved & pcp reported as healthy when seen on day of vax.
Allergies:
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Sudden death while sleeping at night. Post mortem pending. 7/3/07 Received autopsy report which reveals COD as Sudden unexplained death of infancy while co-sleeping w/adult & manner of death as undetermined.


VAERS ID: 275775 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:2007-03-22
Onset:2007-03-23
   Days after vaccination:1
Submitted: 2007-03-23
   Days after onset:0
Entered: 2007-04-09
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B84BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0864H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Had hole in lung at birth - NICU x 2 days on vent.
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type: TN07007

Write-up: Immunizations given 3/22/07 approx 8:30am mom reported mild fever at MN 3/23/07 - gave infant Tylenol drops. Found infant dead in crib 3/23/07 at 7:30AM! 7/3/07 Received Autopsy Report which reveals COD as Undetermined & manner of Death as Undetermined. Final anatomic diagnoses were: clean & apparently well care for; no evidence of trauma or injury; lung & thymus petechiae; and focal mild acute bronchopneumonia of right lung.


VAERS ID: 275990 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-04-10
Entered: 2007-04-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Death, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA00721

Write-up: Information has been received from a physician''s assistant (PA), via a company representative, concerning a female patient who was vaccinated (date unspecified) with a dose of Gardasil the PA reported that "the patient died of a blood clot 3 hours after getting the Gardasil vaccine." The PA clarified that the patient was not vaccinated at her office. Additional information has been requested.


VAERS ID: 276742 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: California  
Vaccinated:2007-04-13
Onset:2007-04-17
   Days after vaccination:4
Submitted: 2007-04-17
   Days after onset:0
Entered: 2007-04-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442F / 3 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Death, Surgery, Truncus arteriosus persistent
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Captopril 0.75 mg/1ml 0.6ml TID, Lasix 10 mg/ml 0.4ml PO BID
Current Illness: No Known short term illness
Preexisting Conditions: Truncus Arteriosis, Intermittent bloody stools
Allergies:
Diagnostic Lab Data: Not Available
CDC Split Type:

Write-up: Truncus arteriosis S/P partial repair. On Lasix and Captopril, Being followed by GI, cardiology. 8/3/07 Received Autopsy Report which reveals COD as failure to thrive due to congenital heart disease, s/p correction of truncus arteriosus.


VAERS ID: 277175 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Georgia  
Vaccinated:2007-02-19
Onset:2007-02-23
   Days after vaccination:4
Submitted: 2007-02-28
   Days after onset:5
Entered: 2007-04-23
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B073AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0403F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674B / 2 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Abdominal injury, Body height, Death, Head injury, Injury, Weight
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-02-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of having asthma
Allergies:
Diagnostic Lab Data: 2/19/07 Wt 15-9 ht 253/4'' - Recertified for WIC
CDC Split Type: GA07010

Write-up: Baby was DOA at hospital. Death certificate listed bruises found on head and cause of death as traumatic injuries of head and abdomen. 4/29 Autopsy states COD as traumatic injuries of head & abdomen. Manner of death: homicide. 4/29/08 Autopsy report states patient experienced irritability, fever, vomiting & diarrhea since vaccination w/o medical attention. Patient had been to ER x 3 for vomiting 3 times since birth, last on 12/7/2006. Contusion in center of forehead noted in ER w/o explanation by parents. Findings at autopsy included: extensive nearly transmural lacerations of the liver w/hemoperitoneum; mod soft tissue bleeding in abdomen, pelvis & lower chest including involvement of left lung; mid-mod SAH; healing posterior paravertebral fractures of right ribs 7 & 11 and left ribs 3-8; mild-mod contusions & abrasions of skin & sq tissue of head, torso & right leg; mild bronchitis & mild trachitis. Metabolic, chemical & tox tests neg. These injuries resulted in a significant amount of bleeding on the surface of the brain & into the abdominal cavity.


VAERS ID: 277269 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:2007-04-16
Onset:2007-04-20
   Days after vaccination:4
Submitted: 2007-04-20
   Days after onset:0
Entered: 2007-04-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C268AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0002U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Peripheral coldness, Sudden infant death syndrome, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 4/20/07 Child received vaccinations at 2 mo visit on 4/16/07. On 4/20/07 around 1 am the mother breast fed baby and put her in the bed between parents. When parents awake at 7 am the baby was unresponsive and cold. Taken to hospital ER where they were unable to revive her. ? SIDS 4/27/07 Received medical records from PCP which reveal patient experienced good health on day of vax. Vax record confirmed RO lot number as reported on VAERS report. 7/11/07-ME report received. COD:Sudden Infant Death Syndrome while co-sleeping w/2 adults.


VAERS ID: 277313 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:2007-04-23
Onset:2007-04-24
   Days after vaccination:1
Submitted: 2007-04-24
   Days after onset:0
Entered: 2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1985CA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1106F / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03252 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA 9/11/07 Received Autopsy Report which states COD as probable suffocation secondary to being placed face down on top a large pillow in the bassinet & having significant livor & blanching of the head & face.


VAERS ID: 277477 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2007-04-05
Onset:2007-04-14
   Days after vaccination:9
Submitted: 2007-04-26
   Days after onset:12
Entered: 2007-04-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1212F / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Anoxic encephalopathy, Blood glucose increased, Carpal tunnel syndrome, Encephalitis, Endotracheal intubation, Inguinal hernia, Monocyte count decreased, Neutrophil count increased
SMQs:, Angioedema (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Ischaemic central nervous system vascular conditions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-13
   Days after onset: 182
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:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: IDDM. Recent URI. Obstructive sleep apnea. Bells palsy x 2 in past 2 years. HTN, hypercholesterolemia.
Allergies:
Diagnostic Lab Data: Unknown LABS from pcp: HgA1C elevated at 9.1, high triglycerides & cholesterol. LABS from hospital: CT & MRI of brain were WNL. EEGs abnormal showing seizure activity & generalized severe encephalopathy. WBC 30,000, Creatinine 4.3, BUN 55, AST 550, ALT 157. CPK 61299. CK MB 82, Troponin 0.15. CSF protein 171, glucose 167, WBC 29, polys 14, neutros 14, lymphs 74, monos 12, c/s neg.Blood c/s (+). Urine & stool c/s (-). Doppler of legs (-).
CDC Split Type: WAES0704USA03666

Write-up: Information has been received from a physician concerning a male who on 05-APR-2007 was vaccinated with a single dose of Zostavax. On 14-APR-2007 (also reported as 17-APR-2007) the patient experienced "encephalitis" and was hospitalized. It was reported that the patient was air lifted to a hospital and was in the ICU. There was no product quality complaint involved. No further information. Additional information has been requested. 5/1/07 T/C to reporter to request missing info. Received patient demographics. 6/15/07 Received provider medical records which included vax lot #. VAERS database updated. Seen in PCP office on 4/5/07 for diet consult re diabetes, wt 301. left inguinal hernia & possible right hand CTS noted. 8/21/07 Received hospital medical records which reveal patient experienced unresponsiveness while at home. Out of state daughter called EMS when no response. Daughter stated patient had c/o stiff neck, sour stomach, weakness & febrile to 104 since zostavax on 4/5/07. Found to be unresponsive w/rash on abdominal area. Glucose was 326. Intubated & helicoptered to ER. Admitted 4/14-5/14/07. Found to be in acute renal failure secondary to rhabdomyolysis & hypotension. Tx w/hemodialysis, pressors, antivirals & antibiotics. Nephrology, neurology & ID consults done. Trached & weaned to trach collar oxygen, feeding tube placement. Weaned from hemodialysis & renal function slowly improving. Remained in comatose state w/poor prognosis at transfer. FINAL DX: viral meningitis, anoxic brain injury. 7/25/08-ventricular arrhythmia. arteriosclerotic cardiovascular disease. 1/4/2010 My brother died Oct 13, 2007. There were mistakes performed in medical center which caused him to go without 02 for 15 minutes. He was only minimaly conscious after that point.


VAERS ID: 277805 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Nevada  
Vaccinated:2007-04-23
Onset:2007-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC14B051B / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM AHBVB360 / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE972AA / 1 RL / SC
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None at present time
CDC Split Type:

Write-up: Baby received 5 shots and died the next day of unknown cause - pending coroner report. 6/8/07 Received Autopsy Report which reveals COD as SIDS.


VAERS ID: 278274 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2006-10-25
Onset:2006-10-27
   Days after vaccination:2
Submitted: 2007-05-09
   Days after onset:194
Entered: 2007-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1008P / 1 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Death, Erythema, Pneumonia, Rash generalised
SMQs:, Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-12-07
   Days after onset: 41
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone 25 mg daily
Current Illness: Pulmonary Fibrosis
Preexisting Conditions: Phenobarbital allergy PMH: prostate cancer, hypothyroidism, LBP, hypercholesterolemia. Allergic to phenobarbital. + prior industrial exposure to automotive fumes & nuclear radiation. Family HX: aunt w/lung cancer, 1st degree cousin w/interstitial lung disease.
Allergies:
Diagnostic Lab Data: Pulmonogist LABS: PFTs done 3/06 revealed restrictive disease & ABG revealed hypooxygenation. CT of chest done 2/06 revealed pulmonary fibrosis & enlarged mediastinal lymph nodes. ANA significantly elevated. EGD revealed esophageal stricture. Bronchoscopy 5/10/06 biopsies & c/s done was non-diagnostic. AFB smear & c/s were neg US of chest revealed interstitial thickening c/w pulmonary fibrosis. Repeat CT scan of chest 6/2/06 was essentially unchanged except for few scatter areas of ground glass opacities. PPD 8/06 was neg. Hospital LABS: creatinine up at 1.4. WBC 14.3 on admit. Blood c/s neg. Sputum c/s grew Aspergillus.
CDC Split Type:

Write-up: Broke out in red rash all over body called Dr office to report it -2 days later was told it wasn''t caused by vaccine, no treatment recommended. Had pneumonia 3 wks later. 5/15/07 Received medical records from pulmonologist which reveal patient experienced dyspnea, cough, night sweats & dysphagia for approx 6 mos when initially evaluated on 3/15/06. He also complained of occasional HA, daytime hypersomnolence, occasional constipation. Exam revealed velcro type rales in bases & clubbing of extremities. Patient referred for open lung biopsy but deferred. Started on supplemental O2. Spirometry done 8/06 & 10/06 revealed worsening restrictive disease. FINAL DX of pulmonologist: idiopathic pulmonary fibrosis. 6/12/07 Received hospital medical records which reveal patient experienced acute flare of interstitial fibrosis; acute renal failure; pneumonia; idiopathic pulmonary fibrosis; prostrate cancer; & GERD. Had increasing SOB, fever/chills, HA & productive cough x 15 days. Admitted 11/20-12/4/06. Treated w/high dose steroids, IV antibiotics & high flow O2. Pulmonary & ID consults done. Very gradually stabilized & was d/c to home on continued oral antibiotics & steroids w/hospice care for poor prognosis. FINAL DX: Acute flare of interstitial fibrosis; acute renal failure; pneumonia; idiopathic pulmonary fibrosis; prostrate cancer; & GERD. 7/17/07 Received Death Certificate which reveals COD as pulmonary fibrosis.


VAERS ID: 278301 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:2007-04-27
Onset:2007-05-06
   Days after vaccination:9
Submitted: 2007-05-08
   Days after onset:2
Entered: 2007-05-10
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF072AA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B036258E / 1 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Autopsy, Diarrhoea, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Milk, soy protein allergy, GERD, was on Nutramigen formula for reflux.
Allergies:
Diagnostic Lab Data: Autopsy pending --$g Medical examiner
CDC Split Type:

Write-up: Pt found in parents bed, face down, not breathing, unresponsive on 5/6/07 at 9am. Mom called office 5/4/07 pt had been having 1 episode diarrhea daily since 4/31/07. No vomiting, no fever, no other signs of illness. 5/15/07 Received vax records from provider which corrected Lot number of RO & & confirmed dose as number 1. VAERS database updated. 6/25/07 SIDS per Proof of Death letter from ME (reported cosleeping w/parents in adult bed, found face down in pillow). Manner of death undetermined.


VAERS ID: 278322 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Unknown  
Vaccinated:2007-03-21
Onset:2007-04-19
   Days after vaccination:29
Submitted: 2007-05-08
   Days after onset:19
Entered: 2007-05-10
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21B084BA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0155U / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681B / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0285F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Autopsy
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reported to me by another PT on about 4/23/07 that patient had died and autopsy was consistent with SIDS. Parents have not returned our calls. 6/21/07 Received vax record from PCP which confirms RO lot & dose number as reported. 8/10/07 Received autopsy report which reveals COD as Undetermined & manner of death as undetermined. Final dx: infant w/age appropriate weight & development found unresponsive while co-sleeping in adult bed in prone sleeping position.


VAERS ID: 278371 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-05-11
Entered: 2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Influenza, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject''s medical history, concurrent conditions, and concurrent medications were not reported.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0650661A

Write-up: This case was reported by a nurse, and described the occurrence of influenza in a subject of unspecified age and gender who was vaccinated with influenza virus vaccine for prophylaxis. The subject''s medical history, concurrent conditions, and concurrent medications were not reported. On an unspecified date, the subject received unspecified dose of Flu vaccine (unknown). The reporting nurse did not have the name of the Flu vaccine that was administered. At an unspecified time after vaccination with Flu vaccine, the subject experienced influenza and lack of efficacy. It was reported that the subject "died from the flu, however, it was unknown which strain of flu the subject died from". It was unknown whether an autopsy was performed. No further information was provided at the time of reporting.


VAERS ID: 278571 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: North Carolina  
Vaccinated:2007-05-03
Onset:2007-05-04
   Days after vaccination:1
Submitted: 2007-05-09
   Days after onset:5
Entered: 2007-05-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1246F / 2 LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Birth HX: NSVD at 37 wkd, apgar 8 & 9, hospital course uncomplicated.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 24 hours. 5/18/07 Received medical records from PCP which reveal patient initial exam in office placed her on wt percentile 2 & ht percentile 14 w/weight of 5 lbs 10 oz. Next vs of 4/12 for parent concern of weight loss. Wt was 5 lbs 8 oz. MD instructed on feeding & planned to hospitalize patient on 4/16 if not improved. Next vs on 5/3 day of vax after having been seen in ER for abdominal pain & received suppositories in ER w/good results. Dx w/constipation. Weight 6 lbs 13 oz. 6/12/07 Rceived vax record from pcp which confirms lot & dose # as reported. 6/21/07 Received autopsy report which reveals COD as SIDS.


VAERS ID: 278670 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Nevada  
Vaccinated:2007-01-09
Onset:2007-02-09
   Days after vaccination:31
Submitted: 2007-05-16
   Days after onset:95
Entered: 2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0408F / 1 LL / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: congenital heart disease PMH: congenital heart disease (transposition of the great vessels, pulmonary atresia, VSD & PDA). Modified Blalock-Taussig shunt & G-tube placement, 9/06 & had remained hospitalized until 11/13/06.
Allergies:
Diagnostic Lab Data: LABS: ECG revealed normal PR, QRS & QT intervals & right ventricular hypertrophy. 2D echocardiogram revealed large VSD, essentially univentricular heart w/normal atrial & ventricular situs & looping w/D-transposed great arteries & pulmonary atresia & systemic-to-pulmonary supply provided by systemic-to-pulmonary artery shunt w/functioning & confluent but small central & brance pulmonary arteries s/o signes of excessive pulmonary over-circulation. BNP was WNL.
CDC Split Type:

Write-up: Irritability and Death from unknown cause within 24-48 hrs of vaccine administration 5/29/07 Received hospital medical records which reveal patient experienced fussiness, crying & then stopped breathing. EMS found patient in asystoly & started CPR & intubated. Resuscitation effort were unsuccessful & patient was pronounced. 6/1/07 Received medical & vax records from PCP which reveal patient received only Hib, Lot # 0408F on 1/9/07. VAERS database updated w/same. Medical records were cardiology clinic reports to PCP. Last report was 1/17/07 which indicated the patient was doing well. Weight was 3.6 kg. O2 sat was 86%. Precordium was overactive & continuous murmur & shunt were noted. Liver was not down. Pulses were intact & accentuated throughout. 6/8/07 Received Death Certificate which reveals COD as cardiopulmonary arrest and congenital heart disease.


VAERS ID: 278688 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2007-03-09
Onset:2007-03-16
   Days after vaccination:7
Submitted: 2007-05-15
   Days after onset:60
Entered: 2007-05-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 00324 / UNK LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-03-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: cholelithiasis, symptomatic but deferred surgery. Positive PPD in past. Ex-smoker. HCM, HOH, hypercholesterolemia, transaminase, insomnia, osteopenia, glaucoma, cataracts, GERD/IBS,
Allergies:
Diagnostic Lab Data: Unknown LABS: EKG showed ST elevations. Troponin 4.44. CXR showed clear lungs. AST 69, Ca 7.7, t. protein 4.4. RBC 3.02, H/H 9.7/29.9, lymphs 5.9, monos 0.8. HBA1C 8.2, free testosterone 7.1
CDC Split Type: WAES0705USA00976

Write-up: Information has been received from a medical assistant concerning a patient who approximately one month ago on 03-APR-2007 was vaccinated with a dose of zoster vaccine live. Within a week, the patient died of a heart attack. No additional information was provided. Additional ifnormation has been requested. 5/18/07 Received records from reporter which included Death Certificate which reveals COD as Inferior myocardial infarction. Records from PCP incidate patient had tetanus updated 1/24/07. Records from ER of 3/16/07 indicate patient seen for syncope or unresponsiveness when passed out in church after complaining to friends that she did not feel well for several days because of her gallbladder. EMS called. BP was unobtainable. Started on Dopamine & given IV fluid bolus. Denied pain & good respiratory effort but restless. O2 sats remained in high 80''s but w/poor perfusion signal. Preparing to administer thrombolytics when became unresponsive & lost pulse. Intubated & coded but unsuccessful resuscitation. FINAL ER DX: acute myocardial infarction, perhaps remote w/continued expansion of infarct leading to cardiopulmonary decline.


VAERS ID: 278865 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2007-03-02
Onset:2007-03-02
   Days after vaccination:0
Submitted: 2007-05-17
   Days after onset:75
Entered: 2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Influenza, Myalgia, Pharyngolaryngeal pain, Pyrexia, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-03-16
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topamax
Current Illness:
Preexisting Conditions: PMH: migraine headaches. Family HX: younger sister also w/strep neg sore throat. Letter from school that group A strep infections present.
Allergies:
Diagnostic Lab Data: Influenza B isolated by viral culture. Specimen sent to CDC for antigenic characterization. LABS: Throat & urine c/s neg. Blood & endotrachael c/s + for MRSA. Nasal swab + for influ B virus. Lymph node c/s were neg. from PCP office, Strep A was neg.
CDC Split Type:

Write-up: Onset of symptoms on 3/1/07: fever, sore throat, cough, and myalgia. Respiratory failure on 3/6/07. 6/1/07 Received Death Certificate from epidemiologist which reveals COD asmultiorgan system failure and influenza B viral sepsis with contributing cause of staphyloccoccal secondary infection. Medical records included w/death certificate indicate patient was transferred to higher level of care on 3/6, was intubated & in PICU w/pneumonia & ARDS. Reportedly had been in good health until 3/1/07 when she developed sore throat, nasal congestion, rhinnorhea & low grade fever. COntinued to worsen & developed myalgias, chest pain & nonproductive cough w/higher fever. Seen by PCP on 3/5 & rapid strep was neg & dx was probable influenza. Sent home & developed nausea, vomiting & diarrhea as well as petechial rash over abdomen. Taken to outlying ER on 3/6 & found to be in respiratory failure, intubated & transferred to higher level of care. Respiratory status declined further & was placed on oscillator & ECMO. Peds ID consult done. Consult states had HPV vax at PCP on 3/2 & no other recent vaccines. 6/1/07 Received fax medical & vaccine records from CDC who had contacted provider. Reveals that on 1/2/07, patient received TDaP & HPV. On 3/2/07 received HPV #2. VAERS database updated w/same. On day of vax patient also dx w/right CTS, migraine HA, scoliosis. She was referred to Neuro & PT for the CTS & HA.


VAERS ID: 278873 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:2007-05-04
Onset:2007-05-05
   Days after vaccination:1
Submitted: 2007-05-17
   Days after onset:12
Entered: 2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF091AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No known illness
Preexisting Conditions: no known preexisting conditions
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unsure of adverse events. Patient died on 5/5/07. 11/16/07 Received autopsy report which states COD as sudden infant death while co-sleeping and hippocampal dysplasia. Sleeping on parent''s chest in prone position and found unresponsive. Had been seen in ER 4/13/07 for apneic episodes. Autopsy also revealed mild laryngopharyngitis & recent history of cold symptoms. 5/29/08 Received vax record which confirms as reported.


VAERS ID: 279405 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Vermont  
Vaccinated:2007-04-19
Onset:2007-04-20
   Days after vaccination:1
Submitted: 2007-05-23
   Days after onset:33
Entered: 2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF021AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8674B / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None.
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Death. 6/12/07 Received Autopsy Report which reveal COD as Undetermined. Found unresponsive face down in bed between parents (anamnestic). No anomalies, trauma, infectious agents or metabolic anomalies detected. Toxicology revealed acetaminophen 6.5 mcg/mL; fluconazole + & caffeine. 6/25/07 Received vax record from pcp which confirms RO lot & dose # as reported.


VAERS ID: 279592 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-05-24
Entered: 2007-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0705USA01964

Write-up: Information has been received from a licensed visiting nurse via a nurse practitioner. The nurse practitioner was told by a friend that a female patient was vaccinated with Gardasil and two weeks alter developed a blood clot. Subsequently the patient died. The cause of death was from the blood clot. The reporting licensed visiting nurse considered the blood clot to be immediately life-threatening and disabling. Additional information has been requested.


VAERS ID: 279975 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:2006-12-07
Onset:2007-01-01
   Days after vaccination:25
Submitted: 2007-05-30
   Days after onset:148
Entered: 2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE917AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0607F / 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: 2007-01-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: bilateral hydroceles
Allergies:
Diagnostic Lab Data: None
CDC Split Type: NH0722

Write-up: Category II SIDS


VAERS ID: 279976 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:2006-12-27
Onset:2007-01-15
   Days after vaccination:19
Submitted: 2007-05-30
   Days after onset:134
Entered: 2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B073AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE916AB / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 8086918408 / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 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: 2007-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: .3ml up to 4x/day 12/11/06 Simethicone 40mg/.6ml for gas
Current Illness: None
Preexisting Conditions: ?Lactose intolerance (according to mom, md note)
Allergies:
Diagnostic Lab Data: None
CDC Split Type: NH0723

Write-up: Category II SIDS


VAERS ID: 280163 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Unknown  
Vaccinated:2007-05-01
Onset:2007-05-04
   Days after vaccination:3
Submitted: 2007-05-31
   Days after onset:27
Entered: 2007-06-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Anaphylactic reaction, Cardiac arrest, Death
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), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0705USA04839

Write-up: Information has been received from a nurse practitioner who heard from an emergency room (ER) nurse that an 11 year old female was vaccinated "within in the past month" in approximately May 2007 with a first dose of Gardasil. Subsequently, 3 days after vaccination the patient presented to an ER. She experienced cardiac arrest, required lung bypass (ECMO) and "may not have expired." It was also reported by the same nurse that the physician from the hospital said that "the death was due to an anaphylactic reaction to Gardasil." The anaphylactic reaction and cardiac arrest were considered to be life threatening by the reporter. Additional information has been requested.


VAERS ID: 280206 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:2007-04-11
Onset:2007-04-12
   Days after vaccination:1
Submitted: 2007-06-01
   Days after onset:50
Entered: 2007-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Feeling hot, Irritability, Skin warm, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocortisone cream 1%
Current Illness: None
Preexisting Conditions: Eczema PMH: atopic dermatitis, seborrheic dermatitis & eczema.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient seen for 4 month well child check on 4/11/2007. Normal exam. Received routine vaccines. That evening, patient noted to be fussy. Improved by 10pm. Placed face down in parents bed. Mother awoke at 5am to find infant hot, unresponsive. Called EMS. Patient unable to be resuscitated and expired. 7/31/07 Received autopsy report which states COD as undetermined & manner of death as undetermined. Patient found unresponsive in prone position while co-sleeping w/parents in adult bed. Temp in ER was 103.2. No congenital anomalies or traumatic injuries found at autopsy. Tox & metabolic tests were neg. Cultures were non contributory.


VAERS ID: 280221 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: California  
Vaccinated:2007-04-11
Onset:2007-04-19
   Days after vaccination:8
Submitted: 2007-05-29
   Days after onset:40
Entered: 2007-06-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691E / 3 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Drug screen negative
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Failure to Thrive
Preexisting Conditions: Failure to thrive, NKMA, No defects
Allergies:
Diagnostic Lab Data: Drug for screen (-), Genetic Screen (-)
CDC Split Type:

Write-up: The cause for pt''s death has yet to be determined. 6/8/07 Rceived medical records & vax records from PCP which confirms vax as reported. Patient had episode of whooping cough at 6 wks of age. Dx w/URI 1/5/07, constipation 1/10/07. Seen in ER 2/19/07 & dx w/fever, cough but was dx w/UTI & started septa. Returned to PCP 2/20 w/fever 104.2, pale w/shiners & was advised to continue antibiotic & symptomatic tx. Returned to PCP on 4/11/07 as well child but had not been gaining weight as expected despite parent report of good appetite. Dx w/failure to thrive & advised lactobacillus qd. Next seen on 4/17 & continued w/constipation, sallow color complexion, had only gained 2# in 4 mos at that time. 10/30/07 Reviewed Autopsy Report which reveals COD as undetermined. Patient had clinical features of failure to thrive w/o source. Possibility of asphyxia by overlaying during co-sleeping w/parent or rare functional disorder, metabolic or otherwise could not be ruled out.


VAERS ID: 280399 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:2006-05-25
Onset:2006-06-10
   Days after vaccination:16
Submitted: 2007-06-05
   Days after onset:360
Entered: 2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHABVB256AA / 1 UN / UN

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: 2006-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: NH0708

Write-up: undetermined/Category II SIDS. baby died in bed with parents. 6/7/06-physical in MD office-no problems noted


VAERS ID: 280676 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-06-01
Entered: 2007-06-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200701873

Write-up: This case was received from a consumer on 22 May 2007. A consumer reported that "her friend''s child died from a DPT shot". No additional information was provided.


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

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=27&PERPAGE=100&DIED=Yes


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