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VAERS ID: 34926 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Virginia  
Vaccinated:1991-08-14
Onset:1991-08-17
   Days after vaccination:3
Submitted: 1991-09-10
   Days after onset:24
Entered: 1991-09-23
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC Split Type: VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


VAERS ID: 34946 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-23
Onset:1990-11-26
   Days after vaccination:3
Submitted: 1991-09-19
   Days after onset:296
Entered: 1991-09-23
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Arteritis, Cerebral haemorrhage, Cough, Encephalopathy, Myalgia, Paraesthesia, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Chronic kidney disease (broad), Tendinopathies and ligament disorders (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: 1991-05-04
   Days after onset: 158
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 48 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pepcid, Synthroid
Current Illness:
Preexisting Conditions: CVA; Hyperthyroidism; Lithiasis, renal; Tuberculosis; Hypertens; Diplopia; Arthritis; Hypothyroidism; Esophageal stricture; Reflux esophagitis; Hiatal hernia; Rhinitis, allergic;
Allergies:
Diagnostic Lab Data: FEB91 ESR 89, 11, 78, 15; ANA 1:320 Homogenous; 28JAN91 Biopsy-Temporal arteritis; FEB91 X-ray-lt lower lobe infiltrate;7FEB91 CT Scan-areas of inc density; 15FEB91 MRI-Multiple parenchymal hemorrhages; 27FEB91 EEG-Mod severe encepahlopathy
CDC Split Type: WAES91090244

Write-up: Pt vaxed 23NOV90 & on 26NOV90 devel a cough which worsened during next wk; fever, myalgia, malaise, & weakness in lower extremities;Polymyalgia rheumatica & temporal arteritis were poss dx; 28JAN91 biopsy pos for arteritis; paresthesias;


VAERS ID: 35080 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1991-08-30
Onset:1991-08-30
   Days after vaccination:0
Submitted: 1991-09-06
   Days after onset:7
Entered: 1991-09-30
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306965 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Instructed to use none; APAP if needed;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WA91618

Write-up: Pt died-SIDS on death certificate; Pt died evening p/immun were given; MD requested vax adverse rxn report be filed; Mom states pt did not seem to have had any reactions to the immun;


VAERS ID: 35089 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-06-17
Onset:1991-07-07
   Days after vaccination:20
Submitted: 1991-09-24
   Days after onset:79
Entered: 1991-09-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow)

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

Write-up: spitting up day before death, no diarrhea, fever;


VAERS ID: 35466 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-09-13
Onset:1991-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT found dead in his crib;


VAERS ID: 35477 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-26
Onset:1991-09-26
   Days after vaccination:0
Submitted: 1991-09-30
   Days after onset:4
Entered: 1991-10-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-26
   Days after onset: 0
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: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC Split Type: LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


VAERS ID: 35493 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1991-10-02
Onset:1991-10-02
   Days after vaccination:0
Submitted: 1991-10-08
   Days after onset:6
Entered: 1991-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1214 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0636B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: Death from apparent SIDS; sudden infant Death Syndrome;


VAERS ID: 35495 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New York  
Vaccinated:1991-09-25
Onset:1991-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence
SMQs:, Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-09-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC Split Type:

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


VAERS ID: 35663 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-10
Onset:1991-09-20
   Days after vaccination:10
Submitted: 1991-09-24
   Days after onset:4
Entered: 1991-10-21
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC Split Type: LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


VAERS ID: 35692 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1991-09-17
Onset:1991-09-19
   Days after vaccination:2
Submitted: 1991-10-12
   Days after onset:23
Entered: 1991-10-21
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 1D21000 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 623K4 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No sx in 1st 24 hrs p/immun; pt found dead in crib on morning of 19SEP91 approx 48hrs p/vax; SIDS dx p/exam in ER @ Hosp & autopsy;


VAERS ID: 35727 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Colorado  
Vaccinated:1991-07-16
Onset:1991-07-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1991-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300921 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165FH / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0631D / UNK MO / PO

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

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

Write-up: Pt had 4mo vax & 4 days a/being brought in DOA w/probable SIDS; MD didn''t feel this was a rxn to the vax but thought it should be reported;


VAERS ID: 35975 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1991-10-14
Onset:1991-10-15
   Days after vaccination:1
Submitted: 1991-10-16
   Days after onset:1
Entered: 1991-11-04
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304920 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0629A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNKNOWN
Current Illness: Well baby;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910194901

Write-up: 2 mo well infant recd 1st DTP/HibTITER/OPV on 14OCT91; 14 hours p/vax, pt died 15OCT91; cause of death diagnosed as SIDS;


VAERS ID: 35987 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-09-04
Onset:0000-00-00
Submitted: 1991-10-10
Entered: 1991-11-04
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120HA / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91162

Write-up:


VAERS ID: 36008 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-09-12
Onset:1991-10-07
   Days after vaccination:25
Submitted: 1991-10-11
   Days after onset:4
Entered: 1991-11-04
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306925 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0639H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 32 wk SGA-apnea ofprematurity-resolved; coag-staph; UTI-resolved;
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN91193

Write-up: DTP/OPV/HIB #1 given 12SEP91-clinically well @ time; pt DOA @ Hosp 7OCT91; unresponsive to resuscitative efforts;


VAERS ID: 36133 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Utah  
Vaccinated:1991-10-11
Onset:1991-10-11
   Days after vaccination:0
Submitted: 1991-10-28
   Days after onset:17
Entered: 1991-11-07
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K21074 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HE / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: multiplebirth defects,tracheostomy on respirator @ home;
Allergies:
Diagnostic Lab Data: autopsy was non-revealing of cause;
CDC Split Type: CO3993

Write-up: Arrested 1 1/2 hrs post inject; resuscitated & put on respirator; 24 hrs later MD discusssed w/parents about d/c life support because pt multiple problems & was non-responsive to current tx; Life support systems d/c pt allowed to die;


VAERS ID: 36170 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1991-02-22
Onset:1991-02-26
   Days after vaccination:4
Submitted: 1991-03-11
   Days after onset:13
Entered: 1991-11-08
   Days after submission:242
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608L / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Petechiae, Pyrexia, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 34 wks gestation @ delivery
Allergies:
Diagnostic Lab Data: Autopsy was performed but will be 2-3 months a/gets reports; Death cert had SIDS as cause of death;
CDC Split Type: GA91300

Write-up: Mom reports pt had slight fever the evening p/the immun 22FEB91 but no other adverse signs;


VAERS ID: 36314 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Georgia  
Vaccinated:1991-10-15
Onset:1991-10-16
   Days after vaccination:1
Submitted: 1991-10-30
   Days after onset:14
Entered: 1991-11-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K21074 / 4 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0638L / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: transfusion dependent anemia, spasticity, extreme failure to thrive
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: Pt found the next morning asystolic full resuscitation attempted;


VAERS ID: 36455 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Texas  
Vaccinated:1991-10-24
Onset:1991-10-26
   Days after vaccination:2
Submitted: 1991-11-12
   Days after onset:17
Entered: 1991-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


VAERS ID: 36536 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Maryland  
Vaccinated:1991-06-25
Onset:1991-07-04
   Days after vaccination:9
Submitted: 1991-11-18
   Days after onset:137
Entered: 1991-11-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Atelectasis, Pneumothorax, Respiratory disorder
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: OM
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: xray showed total lung atelectasis, ipsilateral retraction of the mediastinum, pneumothorax & pneumomediastinum;
CDC Split Type: WAES91110463

Write-up: Pt recvd 1st & 2nd dose of vax & later booster dose HIB vax; On 4JUL91 pt found not breathing; rescusitation was unsuccessful; during intubation, formula noted in trachea;


VAERS ID: 36623 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-07
Onset:1991-10-20
   Days after vaccination:13
Submitted: 1991-11-07
   Days after onset:18
Entered: 1991-11-25
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hyperglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC Split Type: SD91025

Write-up: 20OCT91 pt expired;


VAERS ID: 36624 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-08
Onset:1991-10-09
   Days after vaccination:1
Submitted: 1991-10-28
   Days after onset:19
Entered: 1991-11-25
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Diarrhoea, Nausea, Right ventricular failure, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-14
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ
Current Illness: NONE
Preexisting Conditions: arthritis, hypertension
Allergies:
Diagnostic Lab Data: total bilirubin results inconclusive;
CDC Split Type: SD91026

Write-up: Nausea, vomiting, diarrhea started 9OCT or 10OCT, diarrhea stopped but was still nauseated; MD ordered Phenergan supp 13OCT91; congestive heart failure was reason for death;


VAERS ID: 36644 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:1991-09-23
Onset:1991-09-25
   Days after vaccination:2
Submitted: 1991-10-01
   Days after onset:6
Entered: 1991-11-26
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 0127P / 3 LA / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Hypoxia, Malaise, Respiratory disorder, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gastroenteritis
Preexisting Conditions: moderate to marked atherosclerosis, coronary artery
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91311

Write-up: Pt became ill 2 days following inject; admitted to hosp because of dehydration; died 28SEP91; death certificate-ventricular fibrillation, hypoxia, aspiration, gastric contents;


VAERS ID: 36724 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Connecticut  
Vaccinated:1990-03-02
Onset:1990-03-27
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262914 / 1 - / IM L

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy consistent w/SIDS;
CDC Split Type:

Write-up: SIDS event 1 day following the DTP administration on 26MAR90;


VAERS ID: 36725 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Ohio  
Vaccinated:1991-11-20
Onset:1991-11-22
   Days after vaccination:2
Submitted: 1991-11-25
   Days after onset:3
Entered: 1991-12-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300921 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310957 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd vax 20NOV91 & had no sx until 22NOV91 when pt was placed for nap @ 12PM checked 30 min & found to have no respirations or heart rate; CPR administered but was unsuccessful;


VAERS ID: 36736 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:1991-11-11
Onset:1991-11-12
   Days after vaccination:1
Submitted: 1991-11-25
   Days after onset:13
Entered: 1991-12-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown       Purchased by: Private
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


VAERS ID: 37777 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New York  
Vaccinated:1991-07-08
Onset:1991-11-04
   Days after vaccination:119
Submitted: 1991-12-02
   Days after onset:28
Entered: 1991-12-04
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1581S / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Ascites, Coagulopathy, Coma, Hepatic failure, Hepatic necrosis, Hepatitis, Infection, Intracranial pressure increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness:
Preexisting Conditions: Mom HBAg positive;
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91110702

Write-up: Pt recvd 2nd dose of Hep B vax @ one month of age; subsequently, pt devel fulminant Hep B & was hospitalized for a liver transplant; In mid-November 91, pt died @ 5 months of age;


VAERS ID: 37800 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-08-27
Onset:1991-09-03
   Days after vaccination:7
Submitted: 1991-11-26
   Days after onset:84
Entered: 1991-12-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Confusional state, Convulsion, Headache, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC Split Type: IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


VAERS ID: 37801 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Indiana  
Vaccinated:1991-10-24
Onset:1991-11-02
   Days after vaccination:9
Submitted: 1991-12-03
   Days after onset:31
Entered: 1991-12-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1M11009 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125HF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0635E / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Pneumonia
SMQs:, Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: cold sz w/o fever
Preexisting Conditions: mild upper resp infect @ MD''s office 21OCT91
Allergies:
Diagnostic Lab Data: Autopsy performed-pneumonia was cause of death;
CDC Split Type: IN9132

Write-up: Pt found face down & not breathing on 2NOV91 AM; an ambulance was called but the pt could not be revived;


VAERS ID: 37817 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1991-11-18
Onset:1991-11-18
   Days after vaccination:0
Submitted: 1991-11-19
   Days after onset:1
Entered: 1991-12-09
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (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 (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-11-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


VAERS ID: 37837 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1991-07-12
Onset:1991-07-30
   Days after vaccination:18
Submitted: 1991-12-05
   Days after onset:128
Entered: 1991-12-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC Split Type:

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


VAERS ID: 37838 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arizona  
Vaccinated:1991-10-23
Onset:1991-11-01
   Days after vaccination:9
Submitted: 1991-11-28
   Days after onset:27
Entered: 1991-12-09
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Brother SIDS @ 3mos w/DTP/OPV~ ()~~~In Sibling
Other Medications: Pt also recvd OPV
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Died of SIDS 8 days p/immun;


VAERS ID: 37846 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Arizona  
Vaccinated:1991-10-18
Onset:1991-11-14
   Days after vaccination:27
Submitted: 1991-12-03
   Days after onset:19
Entered: 1991-12-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procardia, Ascriptin
Current Illness: NONE
Preexisting Conditions: previous hx brainstomy tia w/flaccid FEB91
Allergies:
Diagnostic Lab Data: MRI Scan-neg; LP-normal; NCV loss of F waves, slowing;
CDC Split Type:

Write-up: 3 wks post inject pt devel paralysis;


VAERS ID: 37877 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1991-10-25
Onset:1991-11-20
   Days after vaccination:26
Submitted: 1991-12-03
   Days after onset:13
Entered: 1991-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01071P / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Anorexia, Intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Aldactone, Edecrin, Premarin, Prednisone, Ativan
Current Illness: NONE
Preexisting Conditions: Alzheimer''s dementia, CHF, hypertension, chronic lymphedeme
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV9158

Write-up: 20NOV91 began vomiting @ 130AM x 2 refused to eat through the day; no audible bowel sounds @ 715PM & c/o abd tenderness & admitted to Hosp 20NOV; bowel resection completed due to volvolus of bowel;


VAERS ID: 38008 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Male  
Location: Missouri  
Vaccinated:1990-11-16
Onset:1990-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1991-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-21
   Days after onset: 366
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: no prior hx of rxn to DTP/OPV; hx of reactive airway disease;
Allergies:
Diagnostic Lab Data: Autopsy report
CDC Split Type: 900208701

Write-up: Pt recvd vax 16NOV90 & approx 4 days later, 20NOV90 pt had cardiac arrest; Hospitalized & supported by ventilator died 21NOV90;


VAERS ID: 38150 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1991-12-04
Onset:1991-12-04
   Days after vaccination:0
Submitted: 1991-12-20
   Days after onset:16
Entered: 1991-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


VAERS ID: 38163 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:1991-11-06
Onset:1991-11-08
   Days after vaccination:2
Submitted: 1991-11-15
   Days after onset:7
Entered: 1991-12-30
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


VAERS ID: 38173 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:1991-11-25
Onset:1991-11-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HH / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643H / UNK - / -

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

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

Write-up: SIDS; gross autopsy report consistent w/dx of SIDS; DTP, OPV, HIB given 25NOV91; no rxn for 44 hrs p/vax; mom noted irritability for 2 hrs then found pt dead p/being asleep for 2 hrs;


VAERS ID: 38196 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:1991-10-24
Onset:1991-10-28
   Days after vaccination:4
Submitted: 1991-11-13
   Days after onset:16
Entered: 1992-01-02
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312934 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 638M2 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Diarrhoea, Gastroenteritis, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-31
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 24OCT91 normal exam, 1st DTP/OPV/HIB administered; 28OCT91 seen in office for gastroenteritis & acneform rash; 30OCT91 mom called diarrhea, continues, now vomiting also; sent to ER; 31OCT91 pt died;


VAERS ID: 38492 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:1991-12-10
Submitted: 1991-12-17
   Days after onset:7
Entered: 1992-01-08
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Drug ineffective, Infection, Meningitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: well baby
Preexisting Conditions: NONE; pt has several siblings
Allergies:
Diagnostic Lab Data: Autopsy-HIB meningitis; pt was too ill for an LP to be performed;
CDC Split Type: 910235601

Write-up: Pt exp HIB meningitis 2 wks p/initial immun; had severe vomiting w/no fever; later that day 9DEC mom reported pt had fever 100.5 & diarrhea; 10DEC seen in office; pt was morbid; sen to ER & died several hrs later; dx HIB meningitis;


VAERS ID: 38733 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-14
   Days after vaccination:1
Submitted: 1991-12-05
   Days after onset:52
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-17
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


VAERS ID: 38734 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-13
   Days after vaccination:0
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Haematemesis, Hyperhidrosis, Pallor, Right ventricular failure, Tremor
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-15
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt had diabetes, congestive heart failure & a peptic ulcer;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361005J

Write-up: w/in hrs of receiving flu vax pt began shaking & exp vomiting w/a small amount of blood noted; following morning pt exp chest pain, SOB, paleness & clamminess; pt was hospitalized & died 15OCT91; COD congestive heart failure;


VAERS ID: 38735 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-08
Onset:1991-10-13
   Days after vaccination:5
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-26
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


VAERS ID: 38737 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-10-28
Onset:1991-10-28
   Days after vaccination:0
Submitted: 1991-12-10
   Days after onset:43
Entered: 1992-01-13
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


VAERS ID: 38755 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Carolina  
Vaccinated:1991-12-16
Onset:0000-00-00
Submitted: 1991-12-31
Entered: 1992-01-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306964 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature 3-12oz-premture rupture membrane
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC92002

Write-up:


VAERS ID: 38761 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Maryland  
Vaccinated:1992-01-06
Onset:1992-01-09
   Days after vaccination:3
Submitted: 1992-01-11
   Days after onset:2
Entered: 1992-01-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312933 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HH / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312913 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Diarrhoea, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: congestion
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd immun 6JAN92 & had normal exam @ that time; 3 days later was cranky & had some diarrhea later that afternoon was found in crib by babysitter unresponsive; paramedics called & pt taken to local hosp; resusitative efforts unsuccessfu


VAERS ID: 38762 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-12-10
Onset:1991-12-16
   Days after vaccination:6
Submitted: 1992-01-09
   Days after onset:24
Entered: 1992-01-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314958 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 12282 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646E / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102,knot on leg, cried alot on 16DEC91 found dead by father SID death-no autopsy;


VAERS ID: 38763 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1992-01-07
Entered: 1992-01-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / UNK RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC Split Type:

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


VAERS ID: 38811 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Texas  
Vaccinated:1989-12-19
Onset:1989-12-29
   Days after vaccination:10
Submitted: 1991-08-01
   Days after onset:579
Entered: 1992-01-14
   Days after submission:166
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0818P / 1 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Encephalitis, Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-31
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 days p/vax had sz, @ hosp;


VAERS ID: 38816 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: Nevada  
Vaccinated:1991-11-26
Onset:1991-12-18
   Days after vaccination:22
Submitted: 1992-01-07
   Days after onset:20
Entered: 1992-01-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


VAERS ID: 38824 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:1991-11-14
Onset:1991-11-29
   Days after vaccination:15
Submitted: 1992-01-13
   Days after onset:45
Entered: 1992-01-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Cerebral haemorrhage, Convulsion, Gingival bleeding, Haematuria, Myocardial infarction, Petechiae, Thrombocytopenia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Ventricular tachyarrhythmias (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Gingival disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Pt exp generalized weakness, thrombocytopenic purpura, thrombocytopenia @ 43yo~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt was exp to many petro chemicals, paint & glue; suffered from diabetes mellitus type II which was dx last yr & treated w/diet only;
Allergies:
Diagnostic Lab Data: 21NOV91 platelets were 5,000; bleeding time $g10 mins; prothrombin time of 15 vs 12; quick 65%; p/the hosp admission (? 7th day of admission platelet count was 24,000);
CDC Split Type: EBW918091

Write-up: 21NOV91 8(?) days p/2nd dose pt exp thrombocytopenia w/petechiae, bleeding gums & hematuria; Pt hospitalized & anti-platelet antibodies detected; 7th day of admission pt suddenly collapsed w/a fit; cerebral bleeding suspected; mass MI & VF;


VAERS ID: 38828 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1991-11-21
Onset:1991-12-01
   Days after vaccination:10
Submitted: 1991-12-27
   Days after onset:26
Entered: 1992-01-16
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306926 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310959 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: SGA- full term 4lb 10 oz
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt found in crib arrested not able to resuscitate suspected SIDS by med examiner;


VAERS ID: 38869 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:1991-11-01
Onset:1991-12-01
   Days after vaccination:30
Submitted: 1991-12-19
   Days after onset:18
Entered: 1992-01-17
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Not specified;
CDC Split Type: 891360001J

Write-up: Nursing home pt devel a stroke approx 1 month p/being administered flu vax, pt subsequently expired;


VAERS ID: 38961 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:1990-01-09
Onset:1990-01-11
   Days after vaccination:2
Submitted: 1992-01-09
   Days after onset:728
Entered: 1992-01-21
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920006101

Write-up: Plaintiffs allege that as a result of immun on 9JAN90, following which the pt exp an unspecified adverse reaction for which medical care was sought on 11JAN90, pt died on 11JAN90;


VAERS ID: 38984 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:1991-11-08
Onset:1991-11-15
   Days after vaccination:7
Submitted: 1992-01-17
   Days after onset:63
Entered: 1992-01-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK - / A

Administered by: Public       Purchased by: Private
Symptoms: Apnoea, Guillain-Barre syndrome, Myasthenic syndrome, Neuropathy, Paraesthesia, Pneumonia, Pyrexia, Speech disorder
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-04
   Days after onset: 50
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ATB for pneumonia p/hosp
Current Illness: UNK
Preexisting Conditions: heart murmmer, takes Naprosyn
Allergies:
Diagnostic Lab Data: CSF nl, ABG''s nl; CBC-WBC 9,200, HGB 16.1, HCT 44.9; plat 218,000; ESR-6; IgG 421 dec; Drug screen neg; nerve conduction velocity study; suggests GBS, acute polyneuropathy;
CDC Split Type:

Write-up: 15NOV91 tingling fingers & toes lt side numbness rt hand & foot; fatigue & muscular weakness; inc temp speech became more difficult; 19NOV91 placed on ventilator, only able to move lips shrug shoulder (tracheotomy); pneumonia;


VAERS ID: 39013 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Missouri  
Vaccinated:1991-11-15
Onset:1991-11-17
   Days after vaccination:2
Submitted: 1992-01-10
   Days after onset:54
Entered: 1992-01-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306926 / 1 GM / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 1 GM / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06329 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: minor malformation aortic arch-origin lt vert A
Allergies:
Diagnostic Lab Data: post mortem exam consistent w/sids;
CDC Split Type:

Write-up: Pt slept on couch @ home last seen alive 3AM 17NOV91 when mom awakened about 9AM; baby dead;


VAERS ID: 39014 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:1991-11-12
Onset:1991-12-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-15
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


VAERS ID: 39029 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:1991-09-19
Onset:1991-09-20
   Days after vaccination:1
Submitted: 1991-10-28
   Days after onset:38
Entered: 1992-01-24
   Days after submission:88
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0680T / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypokinesia
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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pt recvd Hepatitis B Immune Globulin; Phytonadione, Erythromycin, Ophthalmic
Current Illness: Mom Hep B positive
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood C&S neg, good apgars post partum-9 & 9 @ 1 & 5 minutes; no other significant labs;
CDC Split Type:

Write-up: Immediately post partum, neonate was administered Hep B vax & Hep Immune globulin & 24 hrs later the neonate was found in crib postioned on abdomen w/head turned to lt side, color was cyanotic; no resp, pulse, or spontaneous movements;


VAERS ID: 39041 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1992-01-04
Onset:1992-01-05
   Days after vaccination:1
Submitted: 1992-01-13
   Days after onset:8
Entered: 1992-01-27
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: 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: 1992-01-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


VAERS ID: 39068 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-01-07
Onset:1992-01-08
   Days after vaccination:1
Submitted: 1992-01-09
   Days after onset:1
Entered: 1992-01-27
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310966 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: seen by MD 6JAN92 told mom URI but OK for immun
Allergies:
Diagnostic Lab Data: Autopsy was performed/no significant findings according to MD;
CDC Split Type: TN9211

Write-up: MD reported no other adverse events other than the pt was last seen on 8JAN92 @ 6AM alive & was found on 8JAN92 1130AM dead by mom;


VAERS ID: 39077 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-11-20
Onset:1991-11-20
   Days after vaccination:0
Submitted: 1992-01-20
   Days after onset:61
Entered: 1992-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Myocardial infarction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Calan, Synthroid, Feldene
Current Illness: NONE
Preexisting Conditions: No known allergies; hypertension, hypothyroidism, arthritis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt was administered flu vax @ approx 1215 PM 20NOV91 VS-nl; pt had taken flu vax previously remained in the clinic for 15 to 20mins p/inject; pt passed out on the golf course @ approx 2PM to ER dx MI; no evidence of allergic rxn;


VAERS ID: 39087 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:1991-12-19
Onset:1991-12-19
   Days after vaccination:0
Submitted: 1992-01-24
   Days after onset:36
Entered: 1992-01-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PLAGUE: PLAGUE (NO BRAND NAME) / MILES LABORATORIES - / 3 - / IM A

Administered by: Military       Purchased by: Military
Symptoms: Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt exp urticaria & rash p/vaxs; MAY91 hospitalized for anaphylaxis;~ ()~~~In patient
Other Medications: Pt recvd Japanese B Encephalitis vax by Cannaught Labs SQ 17DEC91;
Current Illness: NA
Preexisting Conditions: Pt had hx of anaphylactic rxn, including bee stings;
Allergies:
Diagnostic Lab Data: Autopsy neg x/for presence of eosinophiles in lungs;
CDC Split Type: 33026

Write-up: Pt recvd Japanese B Encephalitis vax followed in 48 hrs by Plague vax; @ approx 1230AM next day pt was found unresponsive & apparently dead; Pt previously recvd 2 doses of Plague w/no problems reported;


VAERS ID: 39159 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Unknown  
Location: Unknown  
Vaccinated:1991-05-09
Onset:1991-07-22
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS, but was 73 days p/immun;


VAERS ID: 39263 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Oregon  
Vaccinated:1991-10-31
Onset:0000-00-00
Submitted: 1991-12-16
Entered: 1992-01-31
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 3 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: mom HBSAG pos 6SEP90 neg 15JAN91 pt recvd HBIG 21MAR91;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR922

Write-up: Expired 8NOV91 dx SIDS;


VAERS ID: 39274 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-10-28
Onset:1991-11-06
   Days after vaccination:9
Submitted: 1991-12-10
   Days after onset:34
Entered: 1992-01-31
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300922 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0635H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Arrhythmia, Bradycardia, Urinary tract infection
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-11
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: abn 8th chromosome, Av canal pulmonary atresia, PDA, VSD, CHF;
Allergies:
Diagnostic Lab Data: unavailable;
CDC Split Type: WI91088

Write-up: Pt born w/chromosomal & cardiac abnormalities; Hospitalized 6NOV91 w/UTI per clinic; died 11NOV91 COD bradyarrhythmia due to CHF due to congenital heart defect;


VAERS ID: 39281 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1991-11-13
Onset:1991-11-18
   Days after vaccination:5
Submitted: 1992-01-16
   Days after onset:59
Entered: 1992-01-31
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia
SMQs:, Agranulocytosis (broad), Gastrointestinal perforation (narrow), Oropharyngeal infections (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


VAERS ID: 39282 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1991-10-16
Onset:1991-11-27
   Days after vaccination:42
Submitted: 1991-12-18
   Days after onset:21
Entered: 1992-01-31
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560HF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0640K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NONE SIDS death 6 wks after;


VAERS ID: 39283 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1991-10-08
Onset:1991-10-26
   Days after vaccination:18
Submitted: 1991-12-17
   Days after onset:52
Entered: 1992-01-31
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1B21062 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 30948 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt died 26OCT91 attributed to SIDS per autopsy 28OCT91;


VAERS ID: 39284 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1991-01-17
Onset:1991-01-31
   Days after vaccination:14
Submitted: 1992-01-27
   Days after onset:361
Entered: 1992-01-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295977 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Sudden infant death synd;


VAERS ID: 39340 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1992-01-14
Onset:1992-01-15
   Days after vaccination:1
Submitted: 1992-01-15
   Days after onset:0
Entered: 1992-02-04
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0649A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete autospy by MD neg;
CDC Split Type: WA92677

Write-up: Pt found dead in crib presumed by investigators as SIDS;


VAERS ID: 39341 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Washington  
Vaccinated:1991-11-19
Onset:1991-11-20
   Days after vaccination:1
Submitted: 1991-11-20
   Days after onset:0
Entered: 1992-02-04
   Days after submission:76
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 LA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643C / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Adrenal insufficiency, Hypervolaemia, Pulmonary oedema, Pyrexia, Respiratory disorder, Shock, Vasodilatation
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Tempra
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WA92678

Write-up: Went to bed w/o evidence of fever or irritability; found dead by mom in morning;


VAERS ID: 39377 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1992-01-20
Onset:1992-01-22
   Days after vaccination:2
Submitted: 1992-02-04
   Days after onset:13
Entered: 1992-02-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314908 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306956 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Rondec
Current Illness: mild cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy; no abnormality
CDC Split Type:

Write-up: SIDS (crib death);


VAERS ID: 39411 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1992-01-09
Onset:1992-01-18
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1992-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314908 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HJ / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pediazole
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died 18JAN92; last nursed 1800 on 17JAN; slept w/mom when mom awakened @ 0500 on 18JAN, pt was dead; by report, temp was still 101.7 R on arrival in ER;


VAERS ID: 39412 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1992-01-31
Onset:1992-02-01
   Days after vaccination:1
Submitted: 1992-02-05
   Days after onset:4
Entered: 1992-02-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145FJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646L / 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: 1992-02-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: mild congestion
Preexisting Conditions: hernia, hydrocoele, constipation
Allergies:
Diagnostic Lab Data: Autopsy diagnosis SIDS:
CDC Split Type:

Write-up: Hosp notified 1FEB92 that pt had died;


VAERS ID: 39413 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-12-27
Onset:1992-01-20
   Days after vaccination:24
Submitted: 1992-01-29
   Days after onset:9
Entered: 1992-02-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316915 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310928 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SIDS-confirmed;
CDC Split Type:

Write-up: NONE-SIDS death 3 wks p/


VAERS ID: 39455 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:1991-12-14
Onset:1991-12-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


VAERS ID: 39586 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:1992-02-07
Onset:1992-02-08
   Days after vaccination:1
Submitted: 1992-02-12
   Days after onset:4
Entered: 1992-02-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac failure, Coronary artery disease
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: Acute coronary failure secondary to CAD;


VAERS ID: 39615 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Delaware  
Vaccinated:1991-12-16
Onset:1991-12-22
   Days after vaccination:6
Submitted: 1992-02-11
   Days after onset:51
Entered: 1992-02-21
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0642D / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bone marrow depression, Delirium, Haemorrhage, Lung disorder, Petechiae, Pulmonary haemorrhage, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Myelodysplastic syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness: serous otitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4129

Write-up: SIDS;


VAERS ID: 39636 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Missouri  
Vaccinated:1992-01-02
Onset:1992-01-04
   Days after vaccination:2
Submitted: 1992-01-06
   Days after onset:2
Entered: 1992-02-24
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312934 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M580HC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314933 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO92006

Write-up: T101 Thursday 2JAN92 PM-temp controlled w/Tempra; pts death was a result of SIDS;


VAERS ID: 39638 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-02-06
Onset:1992-02-06
   Days after vaccination:0
Submitted: 1992-02-13
   Days after onset:7
Entered: 1992-02-24
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314957 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0635F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC92005

Write-up: Pt was DOA @ ER on 10FEB92; Family reported pt had fun fever since shots on 10FEB92; temp on arrival was 103.4; Pathology report was presumptive SIDS;


VAERS ID: 39709 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wyoming  
Vaccinated:1988-10-28
Onset:1988-10-29
   Days after vaccination:1
Submitted: 1992-02-17
   Days after onset:1206
Entered: 1992-02-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 220951 / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Pallor, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (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: 1988-10-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: Healthy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920028201

Write-up: Plaintiff alleges that pt recvd 1st immun afternoon of 28OC88, & displayed fussiness, inconsolable crying, & altered sleep & feeding patterns; pt was discovered pale about noon 29OCT, & died shortly thereafter;


VAERS ID: 39713 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:1991-12-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Encephalitis, Encephalopathy, Movement disorder, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabinese, Procardia XL, Tenormin, Capoten, Provachol, Aldactone, Lasix;
Current Illness:
Preexisting Conditions: Type II DM-incr chol, HTN, CHF;
Allergies:
Diagnostic Lab Data: EEG-?temporal lobe problem, MRI; lab eval none positive;
CDC Split Type:

Write-up: Pt devel encephalopathy thought to be encephalitis-unknown cause; (initially c/o numbness rt hand x 2 wks opposite arm from inject then deterioration of motor skills & mental status over 5 days;


VAERS ID: 39742 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


VAERS ID: 39743 (history)  
Form: Version 1.0  
Age: 104.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-27
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK GM / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


VAERS ID: 39744 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-10-28
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


VAERS ID: 39745 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-29
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-05
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


VAERS ID: 39746 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-11-06
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308912 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Lasix PRN
Current Illness: mild CHF, end stage liver disease
Preexisting Conditions: NKA, hepatic encephalopathy, hx hyponatremia, mild CHF,dry gangrene;
Allergies:
Diagnostic Lab Data: End stage liver disease 21OCT91 Ammonia level=148 (ref range 11-35); BUN=25, serum creatinine=1.6;
CDC Split Type: HI9206

Write-up: adm dx mild CHF, dry gangrene; final dx cardiac resp arrest, ASCVD, cirrhosis; pt died 7NOV91;


VAERS ID: 39780 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1992-01-27
Onset:0000-00-00
Submitted: 1992-02-03
Entered: 1992-03-04
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306928 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314946 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd vax 27JAN92; Notified on 30JAN92 by parents that pt had expired; clinic requested that VAERS form be completed;


VAERS ID: 39885 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1992-02-14
Onset:1992-02-21
   Days after vaccination:7
Submitted: 1992-02-26
   Days after onset:5
Entered: 1992-03-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M60HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310935 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: granuloma of umbilicus treated w/silver nitrate on 14FEB92
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA92016

Write-up: Pt unable to be aroused on 21FEB92 approx 7AM; rescue squad called, CPR initiated & transported to hosp; unable to resuscitate; cause of death on certificate SIDS; no signs of illness prior to incident;


VAERS ID: 39932 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Utah  
Vaccinated:1992-02-18
Onset:1992-02-18
   Days after vaccination:0
Submitted: 1992-02-19
   Days after onset:1
Entered: 1992-03-09
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1B31125 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0644C / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report pending;
CDC Split Type: 920032201

Write-up: Pt recvd HIB/OPV/DTP on 18FEB92 & 3 hrs later pt died; pt just recently recvd well care check-up which was nl; probable SIDS; autopsy being performed;


VAERS ID: 39988 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-10-01
Onset:1991-10-02
   Days after vaccination:1
Submitted: 1991-10-03
   Days after onset:1
Entered: 1992-03-09
   Days after submission:158
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297905 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 300948 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy showed COD SIDS;
CDC Split Type: PA91321

Write-up: Pt recvd DTP/OPV/HIB #2 in the AM of 1OCT91 pt found dead in crib Tues AM; pt was fine when went to bed Mon night;


VAERS ID: 40098 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-12-10
Onset:1991-12-10
   Days after vaccination:0
Submitted: 1992-01-28
   Days after onset:49
Entered: 1992-03-09
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304922 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125HF / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9235

Write-up: Coroner ruled SIDS death;


VAERS ID: 40207 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Idaho  
Vaccinated:1992-01-27
Onset:1992-01-28
   Days after vaccination:1
Submitted: 1992-03-02
   Days after onset:34
Entered: 1992-03-16
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310966 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0637F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-23
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: ID92020

Write-up: Pt recvd vax on 27JAN92 approx 1PM; began running inc temp approx 9PM; On 28JAN92 inc temp went up to 102; inc temp went up & down; went to PMD 29JAN & on 30JAN hospitalized; 1FEB92 bronchial pneumonia;


VAERS ID: 40221 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-01-17
Onset:1991-02-09
   Days after vaccination:23
Submitted: 1992-03-12
   Days after onset:397
Entered: 1992-03-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295977 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0609K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: congential hip
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 41033 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: retared w/severe hlth problems;
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES91010348

Write-up: Pt died p/recvd vax w/Hep B; @ time of report casue of death was unk; No further details were provided;


VAERS ID: 41034 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt retarded w/severe hlth problems;
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES91010349

Write-up: Pt recvd Hep B vax & died p/receivng vax; @ the time of the report, cause of death was unk; No further details were provided;


VAERS ID: 41035 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES91010350

Write-up: Pt died p/recvd Hep B vax; @ time of report, cause of death was unk; No further details were provided;


VAERS ID: 41036 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relvant data;
CDC Split Type: WAES91010351

Write-up: Pt died p/recvd Hep B vax; @ the time of the report, cause of death was unk; No further details were provided;


VAERS ID: 40309 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:1992-03-13
Onset:1992-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1992-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322909 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312913 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: healthy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd vax 13MAR92 & expired on 14MAR92 @ 1235PM: pt had seizure prior to expiring;


VAERS ID: 40527 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1991-12-16
Onset:1991-12-16
   Days after vaccination:0
Submitted: 1992-01-06
   Days after onset:21
Entered: 1992-03-23
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Haemorrhage, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WA92673

Write-up: SIDS found dead in crib;


VAERS ID: 40551 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1992-03-09
Onset:1992-03-11
   Days after vaccination:2
Submitted: 1992-03-16
   Days after onset:5
Entered: 1992-03-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2013T / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M135HF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-14
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hydorcortisone, Nystatin ointment;
Current Illness: candida diaper derm-oral candiasis
Preexisting Conditions: probable milk allergy 4FEB92; otitis-cleared, thrush 18FEB92;
Allergies:
Diagnostic Lab Data: CT of head, abdomen; autopsy;
CDC Split Type:

Write-up: After being cllinically well, pt was found asystolic w/o respiration; this was felt to be SIDS; resusitation was begun & pt brough to ER; over next 2-3 days pt showed evidence of severe neuro damage & multiple organ failure;


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