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VAERS ID: 40552 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Hampshire  
Vaccinated:1991-06-24
Onset:0000-00-00
Submitted: 1992-03-17
Entered: 1992-03-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 635G6 / 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: 1991-07-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS;


VAERS ID: 40606 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-12-19
Onset:1991-12-20
   Days after vaccination:1
Submitted: 1992-03-20
   Days after onset:91
Entered: 1992-03-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1B31125 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 645K4 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP, Pediacare
Current Illness: NONE
Preexisting Conditions: URI 2 wks prior resolved by 19DEC91;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB & was given APAP for fever; mom lost APAP & gave pt few doses of pedicare; pt found dead in crib next morning 10AM;


VAERS ID: 40811 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Florida  
Vaccinated:1992-03-12
Onset:1992-03-14
   Days after vaccination:2
Submitted: 1992-03-25
   Days after onset:11
Entered: 1992-03-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314958 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700HL / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643L / 1 MO / PO

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

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: cold, runny nose, cough
Preexisting Conditions: complex congenital heart disease (single atrium, single ventricle, pulmonary stenosis, single AV valve, dextrocardia, PDA, inferior vena cava shunt to lt superior vena cava;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died two day p/vax;


VAERS ID: 40951 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-12-19
Onset:1991-12-27
   Days after vaccination:8
Submitted: 1992-03-24
   Days after onset:88
Entered: 1992-04-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21215 / UNK - / IM A

Administered by: Private       Purchased by: Public
Symptoms: Cardiac arrest, Coagulopathy, Dyspnoea, Lactic acidosis, Pharyngitis, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (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), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-01-05
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Chemotherapy w/Cytoxan, Vincristine, Procarbazine, Pred, & Bleomycin
Current Illness: Lymphoma
Preexisting Conditions: lymphoma, leukemia
Allergies:
Diagnostic Lab Data: CXR
CDC Split Type: PA9280

Write-up: 27DEC91 fever, fatigue, weak; 28DEC91 t102, ATB recvd; 31DEC91 fever, cough worse to hosp ER; cxr done; not admitted; 1JAN92 to hosp ER was admitted; heart stopped in ICU died 5JAN92;


VAERS ID: 41018 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-02-11
Onset:1992-02-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1992-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314957 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HJ / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0645H / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete autopsy; no anatomic cause;
CDC Split Type: SD92004

Write-up: DOA- autopsy done; MD couldn''t implicate vax;


VAERS ID: 41125 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:1992-03-04
Onset:1992-03-05
   Days after vaccination:1
Submitted: 1992-03-26
   Days after onset:21
Entered: 1992-04-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31006 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700HC / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0647L / 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: 1992-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: soft cardiac murmur-no organic reason thought
Allergies:
Diagnostic Lab Data: coroner;
CDC Split Type: MO92012

Write-up: SIDS the night or early AM p/vax given;


VAERS ID: 41138 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1992-04-01
Onset:1992-04-02
   Days after vaccination:1
Submitted: 1992-04-02
   Days after onset:0
Entered: 1992-04-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318909 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308979 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt found dead by parents;


VAERS ID: 41169 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Colorado  
Vaccinated:1992-02-05
Onset:1992-02-09
   Days after vaccination:4
Submitted: 1992-02-12
   Days after onset:3
Entered: 1992-04-09
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308982 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0645L / 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: 1992-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Preliminary autopsy results SIDS;
CDC Split Type: CO92016

Write-up: Found deceased in crib morning of 9FEB92 by mom of pt; taken to ER declared dead;


VAERS ID: 41251 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1992-03-23
Onset:1992-03-24
   Days after vaccination:1
Submitted: 1992-03-27
   Days after onset:3
Entered: 1992-04-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322909 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150HN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316958 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dehydration, Delirium, Electrolyte imbalance, Enterocolitis, Infection, Pyrexia, Skin ulcer, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: 2 siblings-no problems following vax; twin sister died 26MAR92 following vax;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood Cultures-neg; Autopsy is currently being performed by med examiner;
CDC Split Type: 920074501

Write-up: 1 of 2 pts (twins) recvd DTP/HBOC/OPV on 23MAR92 & 24MAR devel nausea, vomiting, & fever; Seen in ER on 25MAR & hospitalized; BC neg; pt died w/in 13 hrs of admittance on 25MAR;


VAERS ID: 41252 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1992-03-23
Onset:1992-03-24
   Days after vaccination:1
Submitted: 1992-03-27
   Days after onset:3
Entered: 1992-04-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322909 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150HN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316958 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dehydration, Delirium, Electrolyte imbalance, Enterocolitis, Infection, Pyrexia, Skin ulcer, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-26
   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: 2 siblings-no problems following vax; twin brother died 25MAR92 following vax;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: BC-neg; Autopsy is currently being performed by med examiner;
CDC Split Type: 920074502

Write-up: 1 of 2 pts (twins) recvd DTP/HBOC/OPV on 23MAR92; 24MAR devel nausea, vomiting, & fever; seen in ER on 25MAR & hospitalized; BC neg; pt died 26MAR;


VAERS ID: 41254 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1992-03-30
Onset:1992-04-02
   Days after vaccination:3
Submitted: 1992-04-13
   Days after onset:10
Entered: 1992-04-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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: 1992-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4209

Write-up: Probable SIDS p/vax; well baby visit;


VAERS ID: 41278 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Louisiana  
Vaccinated:1992-03-17
Onset:1992-03-17
   Days after vaccination:0
Submitted: 1992-03-30
   Days after onset:13
Entered: 1992-04-20
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Injection site hypersensitivity, 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), Hypersensitivity (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-22
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SIDS
CDC Split Type: LA920401

Write-up: Redness @ site of inject same day;


VAERS ID: 41281 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1992-03-31
Onset:1992-04-02
   Days after vaccination:2
Submitted: 1992-04-14
   Days after onset:11
Entered: 1992-04-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308924 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308954 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx pneumonia; Seen by MD 31MAR92 AM; nl cxr;
Allergies:
Diagnostic Lab Data: Autopsy- SIDS
CDC Split Type: OK9215

Write-up: 2 days following immun mom had in bed w/her; mom awoke & pt had stopped breathing; Pt taken to hosp & was pronounced DOA;


VAERS ID: 41339 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Virginia  
Vaccinated:1992-03-11
Onset:1992-03-16
   Days after vaccination:5
Submitted: 1992-04-14
   Days after onset:28
Entered: 1992-04-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320906 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 3 RL / -

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: 1992-03-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Ferrin sol drop
Current Illness: NONE
Preexisting Conditions: on 17FEB92 URI & mild anemia, responded to iron
Allergies:
Diagnostic Lab Data: Autopsy done, gross finding not remarkable, final report not available yet;
CDC Split Type:

Write-up: Sudden death 5 days p/DTP/HIB on 11MAR92; pt was seen for well bay check up, was active, alert, & happy, PE was completely nl; Pt seen by M in good hlth; on 16MAR92 pt was placed in playpen @ 5PM & was found dead about 515PM;


VAERS ID: 41340 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1992-03-11
Onset:1992-03-17
   Days after vaccination:6
Submitted: 1992-04-09
   Days after onset:22
Entered: 1992-04-20
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314908 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M665HH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314942 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: laryngomalacia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brought to ER dead p/unable to arouse @ home; probable SIDS;


VAERS ID: 41362 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alaska  
Vaccinated:1992-03-12
Onset:1992-03-29
   Days after vaccination:17
Submitted: 1992-04-02
   Days after onset:4
Entered: 1992-04-22
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310965 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1283T / 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: 1992-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Decongestant from MD
Current Illness: sl cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AK92011

Write-up: Pt dead on 29MAR92 cause of death not yet determined;


VAERS ID: 41374 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: New Hampshire  
Vaccinated:1992-02-26
Onset:1992-03-19
   Days after vaccination:22
Submitted: 1992-03-26
   Days after onset:7
Entered: 1992-04-22
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-21
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


VAERS ID: 41572 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arizona  
Vaccinated:1992-04-15
Onset:0000-00-00
Submitted: 1992-04-23
Entered: 1992-04-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31005 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HN / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 649B5 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: No immediate rxn pt found dead in bed 23APR92;


VAERS ID: 41588 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1992-02-11
Onset:1992-02-11
   Days after vaccination:0
Submitted: 1992-04-23
   Days after onset:71
Entered: 1992-04-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643K / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Cyanosis, Hypotonia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: CHD
Preexisting Conditions: pulmonary artresia & VSD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/congenital heart disease (pulmonary artresia & VSD) w/chronic desaturation but otherwise stable; pt was irritable p/vax & that noc became more irritable & difficult to console; became limp & cyanotic; EMTs called-taken to ER;


VAERS ID: 41658 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Washington  
Vaccinated:1992-03-17
Onset:1992-03-17
   Days after vaccination:0
Submitted: 1992-03-18
   Days after onset:1
Entered: 1992-04-30
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 2 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646L / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Brain oedema, Cardiac arrest, Encephalopathy, Gastrointestinal necrosis, Hepatocellular damage, Pulmonary haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hyponatraemia/SIADH (broad), Ischaemic colitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-03-18
   Days after onset: 1
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Toxicology screen-neg;
CDC Split Type: WA92697

Write-up: Pt adm to ER about 2030 cardiopulmonary arrest-no fever transferred to another hosp & placed on life support-taken off ventilator 2100 18MAR92 & expired;


VAERS ID: 41711 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Louisiana  
Vaccinated:1992-04-01
Onset:1992-04-01
   Days after vaccination:0
Submitted: 1992-04-13
   Days after onset:11
Entered: 1992-05-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC Split Type: LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


VAERS ID: 41773 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:1992-04-28
Submitted: 1992-04-28
   Days after onset:0
Entered: 1992-05-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Unknown
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: 1992-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardio-pulmonary arrest at ER;


VAERS ID: 41862 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Nebraska  
Vaccinated:1991-12-12
Onset:1991-12-22
   Days after vaccination:10
Submitted: 1992-04-30
   Days after onset:129
Entered: 1992-05-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / 7+ LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Anaemia, Asthenia, Malaise, Myelofibrosis, Oedema peripheral, Otitis media
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Blood premalignant disorders (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 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: NE9212

Write-up: 10 days p/flu vax felt poorly-tired; MD tests done found to be very anemic; dx rare acute myleofibrosis of the bone; gets blood transfusions every 2 wks; has also had ear infects & now swelling of the feet is very weak;


VAERS ID: 41868 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: California  
Vaccinated:1992-04-16
Onset:1992-04-24
   Days after vaccination:8
Submitted: 1992-05-05
   Days after onset:11
Entered: 1992-05-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2G31010 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 3 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic serous Lt OM;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recvd vax 16APR92, & expired 24APR92; ?SIDS;


VAERS ID: 41869 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1992-04-27
Onset:1992-04-27
   Days after vaccination:0
Submitted: 1992-04-29
   Days after onset:2
Entered: 1992-05-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560HF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 648H / 1 MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Anorexia, Petechiae, Stupor
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: 1992-04-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pts sibling crying inconsolable, fever @ 3mos w/DTP #1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type:

Write-up: Pt recvd vax @ approx 2PM, poor feeding @ approx 6PM; found unresponsive approx 12AM; DOA on arrival to ER; petechiae on thymus;


VAERS ID: 41896 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:1992-04-29
Onset:1992-05-01
   Days after vaccination:2
Submitted: 1992-05-06
   Days after onset:5
Entered: 1992-05-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322910 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 318946 / 2 MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Lung disorder, 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: 1992-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: mild eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd DTP/OPV/HIB 29APR92 930AM;w/no problems; no fever; no fussy; very active & playful afternoon of 1MAY92; fed 6PM 1MAY92 was OK in crib 15 min later 635PM found pulseless & not breathing; intubated & given meds; ?SIDS, lung congest


VAERS ID: 41897 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Oregon  
Vaccinated:1992-01-15
Onset:1992-01-22
   Days after vaccination:7
Submitted: 1992-03-23
   Days after onset:61
Entered: 1992-05-12
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304951 / 1 MO / PO

Administered by: Private       Purchased by: Other
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: 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: ~ ()~~~In patient
Other Medications: vitamins only
Current Illness: NONE
Preexisting Conditions: smoker, hx IV drugs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS;


VAERS ID: 42033 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Montana  
Vaccinated:1992-04-09
Onset:1992-04-18
   Days after vaccination:9
Submitted: 1992-04-20
   Days after onset:2
Entered: 1992-05-18
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 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: 1992-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MT92007

Write-up: On 7MAR92 pt seen in ER for coughing & gagging episode; no color change; resolved spontaneously; 18APR92 parent checked on pt @ 630; pt appeared fine; checked again 0930 pt was dead preliminary cause of death listed as SIDS;


VAERS ID: 42039 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Texas  
Vaccinated:1992-02-25
Onset:1992-03-07
   Days after vaccination:11
Submitted: 1992-05-11
   Days after onset:64
Entered: 1992-05-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


VAERS ID: 42047 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Michigan  
Vaccinated:1992-04-30
Onset:1992-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1992-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1217A / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643L / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Bronchitis, Cardiac arrest, Cyanosis, Lymphadenopathy, Petechiae, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had a UTI 1st wk of life;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: @ 5AM on 1MAY92 pt was fed & put to sleep, 45 min later pt was foun blue & not breathing; despite CPR & ALLS rescue techniques pt died;


VAERS ID: 42073 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1991-08-21
Onset:1991-08-21
   Days after vaccination:0
Submitted: 1992-05-18
   Days after onset:271
Entered: 1992-05-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Bronchitis, Convulsion, Febrile convulsion, Gastroenteritis, Hemiplegia, Hypokinesia, Meningitis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-03-18
   Days after onset: 210
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 19NOV91 CSF-nl; 18JAN92 BC-pos alapha strep; 23AUG91 CT Scan-nl; MRI-nl
CDC Split Type: WAES91090035

Write-up: Pt recvd 2nd dose HIB vax 21AUG91 & exp tonic-clonic activity; pt taken to ER; flaccid; taken to another hosp dec movement of extremities; hemiparesis; weakness; 7SEP91 febrile sz & aseptic meningitis; gastroenteritis, bronchitis, epileptic


VAERS ID: 42200 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Oregon  
Vaccinated:1992-03-23
Onset:1992-04-01
   Days after vaccination:9
Submitted: 1992-05-04
   Days after onset:32
Entered: 1992-05-28
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 2 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308960 / 2 - / -

Administered by: Other       Purchased by: Public
Symptoms: Dyspnoea, Pharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-03
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Valium, Phenobarb, Zantac, Vancenase spray;
Current Illness: resp failure due to aspiration
Preexisting Conditions: Perinatal anoxia, seizure disorder, apnea, reflux no swallow, tube feedings
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR9236

Write-up: Pt recvd vax 23MAR92 no apparent fever until 1APR92 when pt had inc resp difficulties & fever; pt was treated w/APAP & decongestants until 3APR92 when ATB & inhalatin tx ordered pt expired a/recvd tx;


VAERS ID: 42220 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: Wyoming  
Vaccinated:1991-10-18
Onset:1991-10-21
   Days after vaccination:3
Submitted: 1991-10-22
   Days after onset:1
Entered: 1992-05-28
   Days after submission:219
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


VAERS ID: 42254 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1992-03-04
Onset:1992-03-08
   Days after vaccination:4
Submitted: 1992-05-22
   Days after onset:74
Entered: 1992-05-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308924 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HJ / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 646L6 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (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), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: recovering from URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS, nl;
CDC Split Type: PA92139

Write-up: Sudden unexplained infant death of 8MAR92; mom found pt w/o heart beat or resp;


VAERS ID: 42321 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:1990-06-27
Onset:0000-00-00
Submitted: 1992-05-29
Entered: 1992-06-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 585A4 / 3 - / -

Administered by: Other       Purchased by: Other
Symptoms: Gastrointestinal carcinoma
SMQs:, Non-haematological malignant tumours (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: Pt recvd Engerix B 6DEC89 & 11JAN90 lot# 587A4;
Current Illness:
Preexisting Conditions: Pt is lab employee; hx of breast cancer pre vax series
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU921212

Write-up: Pt recvd 3 doses of Engerix B; a/titer was checked pt died as a result of pancreatic cancer; dx p/completion of vax series; cancer & subsequent death were considered not related to vax series;


VAERS ID: 42346 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1992-04-30
Onset:1992-04-30
   Days after vaccination:0
Submitted: 1992-05-18
   Days after onset:18
Entered: 1992-06-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0644M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Aortic valve stenosis, Apnoea, Brain oedema, Cardiac arrest, Cardiomegaly, Cardiovascular disorder, Lung disorder, Pulmonary haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WA92720

Write-up: healthy pt made funny face, face turned red, appeared to be holding breath; mom determined not breathing, gave couple puffs, dialed 911; pulmonary artery & aorta w/fibromuscular thickening & stenosis; cardiomegaly; pulmonary congest & hem


VAERS ID: 42457 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:1991-12-19
Onset:1991-12-20
   Days after vaccination:1
Submitted: 1992-06-01
   Days after onset:163
Entered: 1992-06-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PLAGUE: PLAGUE (NO BRAND NAME) / MILES LABORATORIES 10H10A / 3 - / IM A

Administered by: Military       Purchased by: Military
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Cardiac arrest, Laryngitis, Lung disorder, Pulmonary oedema, Urinary tract disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: DPH; pt also had Japanese encephalitis BIKEN/Connaught lot# 49 or 55; 17DEC91;
Current Illness: NONE
Preexisting Conditions: recurrent anaphylaxis, etiology unk
Allergies:
Diagnostic Lab Data: Toxicology drug screen @ autopsy found only lidociane, presumeably from resuscitation; autopsy found no cause of death, identified death as natural, but commented that anaphylaxis was likely cause;
CDC Split Type:

Write-up: Pt recvd plague vax sometime during 19DEC91; @ about 2300 that day, pt was noted by roommate to be reading in bed, healthy & in no distress; about an hr later, roommate awoke to go to bathroom & find pt dead on floor;


VAERS ID: 42471 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1992-03-18
Onset:1992-03-18
   Days after vaccination:0
Submitted: 1992-04-30
   Days after onset:42
Entered: 1992-06-05
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1217A / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HB / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646C / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-29
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sister: t103, 22 mos; DPT #2, OPV #2, MMR #2;~ ()~~~In Sibling
Other Medications: Ceclor & Ventolin
Current Illness: URI
Preexisting Conditions: allergic to milk-URI
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MI92054

Write-up: Had fever p/vax of 99.4 & then to 101 lasted 2 days; never higher than 101; both upper & lower legs were swollen;


VAERS ID: 42588 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1992-04-03
Onset:0000-00-00
Submitted: 1992-04-30
Entered: 1992-06-08
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304520 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HG / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0649M / 1 MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Influenza
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-08
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: slow wt gain? formula intolernce
Allergies:
Diagnostic Lab Data: RSV
CDC Split Type: TX9266

Write-up: DOA hosp ER 8APR92 AM; death not felt to be vax related;


VAERS ID: 42844 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1992-03-24
Onset:0000-00-00
Submitted: 1992-04-02
Entered: 1992-06-15
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312936 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0642M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Haemorrhage, Lung disorder, Pulmonary haemorrhage, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-31
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: GA9286

Write-up: Found in bed not breathing-CPR began by mom-EMT''s;


VAERS ID: 42890 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:1992-05-13
Onset:1992-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1992-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322913 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Asphyxia, Cardiac arrest, Encephalopathy, Grand mal convulsion, Haemorrhage, Lactic acidosis, Petechiae, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Respiratory failure (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: 1992-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO92035

Write-up: Pt was found cynotic in bed 15MAY92; pt was taken to hosp; asphyxial death consistent w/SIDS;


VAERS ID: 42901 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Jersey  
Vaccinated:1992-05-28
Onset:1992-05-28
   Days after vaccination:0
Submitted: 1992-06-01
   Days after onset:4
Entered: 1992-06-17
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 - / IM L

Administered by: Private       Purchased by: Private
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: 1992-05-30
   Days after onset: 2
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: Lanoxin; Pt recvd DTP/OPV 27APR92 lot#''s 308923 & 308981;
Current Illness:
Preexisting Conditions: downs synd, congenital heart AV canal, patent ductus arteriosus;
Allergies:
Diagnostic Lab Data: Autopsy is being performed-awaiting results;
CDC Split Type: 920222201

Write-up: Pt recvd vax 28MAY92 @ 2PM & @ 530PM had fever of 103.4; MD recommended APAP & sponge bath via phone; 29MAY fever of 101; no other sx; 30MAY @ 5AM temp nl; found dead in crib @ 630AM; Autopsy being performed;


VAERS ID: 42913 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Montana  
Vaccinated:1992-06-10
Onset:0000-00-00
Submitted: 1992-06-11
Entered: 1992-06-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 29875913 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Oedema, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Vasodilatation
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-11
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: MT92010

Write-up: not known-was not seen by regular hlth care provider prior to death;


VAERS ID: 43060 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New Jersey  
Vaccinated:1992-06-08
Onset:1992-06-09
   Days after vaccination:1
Submitted: 1992-06-09
   Days after onset:0
Entered: 1992-06-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2G31010 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M185HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0649F / 2 MO / PO

Administered by: Private       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: 1992-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB 8JUN92 & APAP was given for fever; MD recvd a call on 9JUN92 that pt died @ 7AM; Called ME @ 315 on 9JUN92 pt was sleeping w/mom & grandma found pt dead;


VAERS ID: 43158 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: Montana  
Vaccinated:1992-03-27
Onset:1992-05-22
   Days after vaccination:56
Submitted: 1992-06-16
   Days after onset:25
Entered: 1992-06-25
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298193 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M290HR / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320930 / 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: 1992-05-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy done;
CDC Split Type: MT92013

Write-up: Infant died 22MAY92 from apparent SIDS;


VAERS ID: 43166 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:1992-05-08
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K4709 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure, Endocarditis, Infection
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: Autopsy planned;
CDC Split Type: WAES92060551

Write-up: Pt recvd MMR vax on 8MAY92 & devel bacterial endocarditis complicated by heart failure & was hospitalized; 13JUN92 pt died due to bacterial endocarditis complicated by heart failure; autopsy is planned;


VAERS ID: 43261 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Arizona  
Vaccinated:1991-08-28
Onset:1991-09-06
   Days after vaccination:9
Submitted: 1992-06-04
   Days after onset:272
Entered: 1992-06-30
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC Split Type:

Write-up:


VAERS ID: 43309 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Colorado  
Vaccinated:1989-06-28
Onset:1989-06-28
   Days after vaccination:0
Submitted: 1992-06-28
   Days after onset:1096
Entered: 1992-07-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Injection site oedema, Pyrexia, Somnolence, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-11-19
   Days after onset: 874
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: allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: high fever 103 to 104.1, lethargic for 7 days, no appetite for 2 wks; localized & severe swelling @ inject site; blood disorder;


VAERS ID: 43310 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Texas  
Vaccinated:1992-01-07
Onset:1992-01-08
   Days after vaccination:1
Submitted: 1992-06-12
   Days after onset:155
Entered: 1992-07-02
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 2 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0983T / 1 - / IM L

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Diarrhoea, Encephalopathy, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Pt recvd MMR/HIB 7JAN92 & seen in clinic w/fever, vomiting, diarrhea 10JAN92; 13JAN92 was much improved; seen in clinic 6MAR92 w/ataxia, listlessness adm to hos 17MAR92 dx leukoencephalopathy


VAERS ID: 43356 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-06-26
Onset:1992-06-26
   Days after vaccination:0
Submitted: 1992-06-30
   Days after onset:4
Entered: 1992-07-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M600JA / 1 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Hypertonia, Hypothermia, Pneumothorax, Skin discolouration, 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), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-27
   Days after onset: 1
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to ER in cardiopulmonary arrest; asystole; unresponsive, cold, stiff, eyes fixated, mottling;


VAERS ID: 43358 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Kansas  
Vaccinated:1989-05-03
Onset:1989-05-04
   Days after vaccination:1
Submitted: 1992-06-19
   Days after onset:1142
Entered: 1992-07-06
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 232967 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 229942 / 2 - / -

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Anorexia, Insomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had shots 3MAY89 that evening pt was very cranky & irritable; pt didn''t want to be touched that noc pt kept getting up; crying had a fever; wasn''t hungry next day died;


VAERS ID: 43425 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-03-04
Onset:1992-03-07
   Days after vaccination:3
Submitted: 1992-06-15
   Days after onset:99
Entered: 1992-07-10
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / L

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Dyspnoea, Hypotonia, Malaise, Movement disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 6months w/DTP #3;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: ? neuropathy
Allergies:
Diagnostic Lab Data: EMG, CSF study;
CDC Split Type: NC92026

Write-up: 3-4 days later pt had loss of head control, unable to sit w/o propping, arms limp, weak cry, labored breathing; listless called MD x 5 days p/vax; returned to hosp 11MAR92 for further eval;


VAERS ID: 43426 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: North Carolina  
Vaccinated:1991-09-09
Onset:1991-09-09
   Days after vaccination:0
Submitted: 1992-06-15
   Days after onset:280
Entered: 1992-07-10
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300920 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HB / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Movement disorder, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC92027

Write-up: irritable for 1 wk following vax; elevated temp for 1 wk following vax; mom notes hands & arms turning inward; loss of control in upper extremities by 20DEC91;


VAERS ID: 43495 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Washington  
Vaccinated:1992-07-03
Onset:1992-07-03
   Days after vaccination:0
Submitted: 1992-07-07
   Days after onset:4
Entered: 1992-07-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654A / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Diarrhoea, Dyspnoea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: pulmonary hypertension @ 2 wks secondary to sepsis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: diarrhea & vomitting first 24 hrs; resp distress on 2nd day; arrest on the way to the hosp;


VAERS ID: 43538 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1992-05-20
Onset:1992-05-29
   Days after vaccination:9
Submitted: 1992-07-13
   Days after onset:45
Entered: 1992-07-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Cyanosis, Insomnia, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (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: 1992-05-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pending due to autopsy;
CDC Split Type:

Write-up: pt woke up approx 12AM on 30MAY crying mom felt head was warm; wouldn''t go back to sleep-kept moaning & dozing off; pt very flush & lips were turning purple; pt taken to ER;


VAERS ID: 43579 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Washington  
Vaccinated:1992-05-18
Onset:1992-05-26
   Days after vaccination:8
Submitted: 1992-06-08
   Days after onset:13
Entered: 1992-07-20
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: 5 days prior @ Swedish conv ER
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type: WA92726

Write-up: brought in ER as moribund & stiff;


VAERS ID: 43596 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Massachusetts  
Vaccinated:1982-09-30
Onset:1982-10-04
   Days after vaccination:4
Submitted: 1992-06-22
   Days after onset:3549
Entered: 1992-07-20
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Delirium, Hepatitis, Hepatocellular damage, Infection, Myocarditis
SMQs:, Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1982-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp high fever, convuls @ 15mos w/MMR #1 dose;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Extensive viral studies isolated type II polio in heart & liver;
CDC Split Type:

Write-up: death due to myocarditis; due to type II polio virus-due to oral sabin polio vax; also found hepatitis & disease liver, & brain lesions;


VAERS ID: 43601 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-05-15
Onset:1992-06-14
   Days after vaccination:30
Submitted: 1992-07-05
   Days after onset:21
Entered: 1992-07-20
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238V / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M185HF / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0123 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-14
   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: fluoriode drops, Proventil inhaler
Current Illness: undergoing eval for resp prob
Preexisting Conditions: atrial septal defect; known obstructive hydronephrosis
Allergies:
Diagnostic Lab Data: post mortem;
CDC Split Type:

Write-up: found dead in crib;


VAERS ID: 43631 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1992-07-01
Onset:1992-07-02
   Days after vaccination:1
Submitted: 1992-07-07
   Days after onset:5
Entered: 1992-07-21
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31006 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-02
   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: NONE
Current Illness: NONE
Preexisting Conditions: premature pt 34 wk gestation
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9258

Write-up: pt died w/in 24 hrs from time of vax Dx; coroner''s office autopsy-sids;


VAERS ID: 43650 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:1992-07-08
Onset:1992-07-09
   Days after vaccination:1
Submitted: 1992-07-10
   Days after onset:1
Entered: 1992-07-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326908 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 324945 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary haemorrhage, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 2 mos of age 1 day p/vax; no known relationship, but timing of sids death warranted report;


VAERS ID: 43651 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1992-07-01
Onset:1992-07-04
   Days after vaccination:3
Submitted: 1992-07-16
   Days after onset:12
Entered: 1992-07-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP279 / 1 LL / -

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: 1992-07-04
   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: Suprax;
Current Illness: resolving bilat OM;
Preexisting Conditions: cleft palate; s/p neonatal narcotic withdrawl;
Allergies:
Diagnostic Lab Data: post mortem exam SIDS:
CDC Split Type:

Write-up: pt had no sx following admin of vax; fed normally @ 630AM; 4JUL put back to bed was found apneic @ 830AM; taken to local ER where resuscitation unsuccessful; autopsy SIDS;


VAERS ID: 43712 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Oregon  
Vaccinated:1992-05-19
Onset:1992-06-10
   Days after vaccination:22
Submitted: 1992-06-16
   Days after onset:6
Entered: 1992-07-24
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1712S / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp elevated temp @ 16 1/2 mos w/DTP/OPV/HIB/PPD #1 dose;~ ()~~~In patient
Other Medications: PPD by Connaught lot# 233121 29APR91; polyviflor; tums;
Current Illness: afebrile, chronic vegetative state
Preexisting Conditions: abruptio placenta-birth asphyxia-persistent vegetative state microcephaly, temp instability, acute renal tubular necrosis;
Allergies:
Diagnostic Lab Data: G-tube culture/purulent dr/gm stain no bacteria; prelim results WBC''s +1 gm neg bacilli +1; gm pos cocci +1;
CDC Split Type: OR9238

Write-up: 10JUN92 230PM resp distress, color bluish, temp elevated; 02 placed, resp tx given, suctioned, APAP given for temp sudafed given no effect; 730PM resp & cardiac arrest, no code;


VAERS ID: 43807 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kentucky  
Vaccinated:1992-03-23
Onset:1992-04-03
   Days after vaccination:11
Submitted: 1992-04-08
   Days after onset:4
Entered: 1992-07-29
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0651C / 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: 1992-04-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: prelim autopsy-SIDS;
CDC Split Type: KY920010

Write-up: pt found lifeless in crib by mom; autopsy reveals SIDS;


VAERS ID: 43820 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Kentucky  
Vaccinated:1992-05-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310965 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310933 / 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: 1992-06-04
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:
Preexisting Conditions: fx (r) clavicle @ birth (vag);
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY920023

Write-up: SIDS death 4JUN92;


VAERS ID: 43839 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1992-06-12
Onset:1992-06-14
   Days after vaccination:2
Submitted: 1992-07-16
   Days after onset:32
Entered: 1992-07-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318906 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 322945 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Atelectasis, Cough, Lung disorder, Petechiae, Pulmonary oedema, Pyrexia, Rhinitis, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: 1992-07-01
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sister exp fussiness following vax;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nl delivery; C-sect;
Allergies:
Diagnostic Lab Data: Autopsy: dx SIDS;
CDC Split Type: 920270301

Write-up: Pt recvd DTP/HBOC/OPV 12JUN92 & w/in 24hrs exp fussiness & low grade fever; tx included APAP & runny nose & low grade fever off & on; 1 wk later fever & coughing; 1JUL92 med cont; 7AM found dead in crib;


VAERS ID: 43841 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1992-07-13
Onset:0000-00-00
Submitted: 1992-07-25
Entered: 1992-07-30
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 322945 / 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: 1992-07-14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Nystatin oral susp
Current Illness: NONE x//thrush
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died suddenly @ 5PM @ sitters shortly p/being layed down for a nap; presumed SIDS;


VAERS ID: 43900 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1992-07-07
Onset:1992-07-07
   Days after vaccination:0
Submitted: 1992-07-21
   Days after onset:14
Entered: 1992-08-04
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310964 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320957 / 1 MO / PO

Administered by: Unknown       Purchased by: Public
Symptoms: Bronchiolitis, Convulsion, Encephalopathy, Hepatic steatosis, Leukaemoid reaction, Myocardial infarction, Pneumonia, Renal tubular necrosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Renovascular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-14
   Days after onset: 7
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: FL92038

Write-up: Pt vaxed 7JUL92 & 14JUL92 had cardiopulmonary arrest in hosp & died; mom states pt had temp 102-103 1st 24 hrs, crying & difficulty of breathing on & off whole wk; pt taken to hosp because stopped breathing; myocardial infart, leukomoid rxn


VAERS ID: 43903 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-07-24
Onset:1992-07-26
   Days after vaccination:2
Submitted: 1992-07-27
   Days after onset:1
Entered: 1992-08-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322914 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type: TN9292

Write-up: Mom fed pt @ 230AM; awoke 3-4 hrs later & found pt w/o pulse & or respirations; No CPR done;


VAERS ID: 43904 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1992-02-12
Onset:1992-02-12
   Days after vaccination:0
Submitted: 1992-07-15
   Days after onset:153
Entered: 1992-08-04
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308924 / 1 GM / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308959 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Bronchitis, Dementia, Depressed level of consciousness, Dyspnoea, Hypersensitivity, Lung disorder, Mental retardation severity unspecified
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: various neurologic tests-CAT Scans, EEGs, MRIs, spinal tap, PET; BEARS test, muscle bio., skin bio., blood test, chrom test;
CDC Split Type:

Write-up: 2 hrs onset to severe resp congestion; MD dx as bronchitis but 2 hrs later @ hosp stopped breathing; various CNS difficulties-developmental delay; raspyyness & congestion; resp failure; quit breathing;


VAERS ID: 43906 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Louisiana  
Vaccinated:1992-07-13
Onset:1992-07-13
   Days after vaccination:0
Submitted: 1992-07-14
   Days after onset:1
Entered: 1992-08-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314970 / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0430V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314936 / 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: 1992-07-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy-no cause of death found; dx SIDS;
CDC Split Type:

Write-up: pt died;


VAERS ID: 43929 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Iowa  
Vaccinated:1992-03-31
Onset:1992-04-02
   Days after vaccination:2
Submitted: 1992-07-24
   Days after onset:112
Entered: 1992-08-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310965 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310956 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Diarrhoea, Muscle atrophy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hernia repair JAN92;
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA92032

Write-up: 2 days p/vax pt vomiting, t102-103 A; no appetite, diarrhea lasting 5 wks; 14JAN92 dx w/Werdnig-Hoffman disease @ hosp;


VAERS ID: 43953 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:1991-10-14
Onset:1991-10-25
   Days after vaccination:11
Submitted: 1992-07-08
   Days after onset:257
Entered: 1992-08-06
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920262501

Write-up: cerebrovascular accident (lt hemisphere) in pt, 10 days p/vax w/fluvirin; pt was vaxed on 14OCT91 & died 25OCT91; no other clinical info available;


VAERS ID: 43970 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-10-11
Onset:1990-11-15
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 1992-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11208 / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Myasthenic syndrome
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-16
   Days after onset: 121
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: many, including LP, EMG;
CDC Split Type:

Write-up: progressive LE weakness, GBS;


VAERS ID: 43971 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arizona  
Vaccinated:1992-07-28
Onset:1992-07-30
   Days after vaccination:2
Submitted: 1992-08-03
   Days after onset:4
Entered: 1992-08-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205HL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 328963 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Cardiovascular disorder, Hepatocellular damage, Lung disorder, Pyrexia, Skin discolouration, Sudden infant death syndrome, Urinary tract disorder
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had t101 to 102 died on 30JUL92;


VAERS ID: 44074 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: California  
Vaccinated:1991-11-14
Onset:1991-11-21
   Days after vaccination:7
Submitted: 1992-02-19
   Days after onset:90
Entered: 1992-08-10
   Days after submission:172
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: CA9277

Write-up: pt had a massive heart attack;


VAERS ID: 44075 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1992-07-01
Onset:1992-07-05
   Days after vaccination:4
Submitted: 1992-07-06
   Days after onset:1
Entered: 1992-08-10
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31006 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306969 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE Known;
CDC Split Type: CA9278

Write-up: None known; pt was given PE 1JUL92 & no abnormal findings noted;


VAERS ID: 44121 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1992-05-08
Onset:1992-05-11
   Days after vaccination:3
Submitted: 1992-08-04
   Days after onset:85
Entered: 1992-08-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31006 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HF / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0640A / 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: 1992-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tri-vi-flor vits
Current Illness: NONE
Preexisting Conditions: foster child secondary to maternal drugs;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 11MAY92;


VAERS ID: 44182 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maryland  
Vaccinated:1991-03-04
Onset:1991-03-09
   Days after vaccination:5
Submitted: 1992-08-14
   Days after onset:523
Entered: 1992-08-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 2377S / 1 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Bronchiolitis, CSF test abnormal, Cerebral infarction, Convulsion, Drug ineffective, Electroencephalogram abnormal, Meningitis, Neuropathy
SMQs:, Lack of efficacy/effect (narrow), Peripheral neuropathy (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Eosinophilic pneumonia (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? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 25 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: WAES92070614

Write-up: Pt recvd 1st dose of HIB on 4MAR91 & on 23MAR91 devel meningitis & exp was considered life-threatening; no further details were provided;


VAERS ID: 44183 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Unknown  
Location: Unknown  
Vaccinated:1992-04-10
Onset:1992-07-18
   Days after vaccination:99
Submitted: 1992-08-14
   Days after onset:27
Entered: 1992-08-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0883T / 1 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES92070615

Write-up: Pt recvd 1st dose of HIB on 10APR92 & pt recvd prior doses of HIBTITER on 4DEC91 & 7FEB92; On 18JUL92 pt devel meningitis; pts exp was considered life-threatening; No further details were provided;


VAERS ID: 44185 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Texas  
Vaccinated:1992-07-01
Onset:1992-07-08
   Days after vaccination:7
Submitted: 1992-08-13
   Days after onset:36
Entered: 1992-08-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Convulsion, Diarrhoea, Enzyme abnormality, Hepatic steatosis, Hypertonia, Lymphadenopathy
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Parkinson-like events (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), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-09
   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: Cefzil; Pediotic;
Current Illness: chicken pox 6 wks prior to vax; ear infe
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Glucose-30;post mortem: fatty liver infiltrate;
CDC Split Type: EBU921833

Write-up: Pt recvd Engerix-B vax & 8JUL92 PM exp intestinal malady (diarrhea); 9JUL92 AM exp teeth clenching & a ? sz; pt was not able to be resusciated; pt died 9JUL92; Reporter indicated that did not feel that event was related to vax;


VAERS ID: 44200 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Texas  
Vaccinated:1992-07-24
Onset:1992-07-24
   Days after vaccination:0
Submitted: 1992-07-28
   Days after onset:4
Entered: 1992-08-17
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 326955 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Coma, Convulsion, Encephalitis, Pyrexia, Stupor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (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: 1992-07-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: urinary tract infect @ 1mo & had convuls; Bronchitis in JUN92;
Allergies:
Diagnostic Lab Data: hospitalized on 25JUL92 @ 1PM;
CDC Split Type: TX92136

Write-up: Pt started w/fever on 24JUL92 AM & mom gave Tempra fever went up to 103 & mom started bathing pt in cold baths; Mom took pt to MD started staring blank & convuls adm to hosp & had cardiac arrest;


VAERS ID: 44298 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:1992-06-11
Onset:1992-06-15
   Days after vaccination:4
Submitted: 1992-08-17
   Days after onset:63
Entered: 1992-08-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Arthralgia, Dyspnoea, Hypersensitivity, Hypoxia, Pleural effusion, Pneumonia, Serum sickness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-08-14
   Days after onset: 60
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: open lung biopsy done on 18JUL92; showed hypersensitivity rxn w/eosinophilic infiltration & no immune complex deposits; ANA mildly elevated; work-up unremarkable for connective tissue disease; cult neg; SLE neg;
CDC Split Type: EBU921841

Write-up: 4 days post vax exp urticaria, arthralgias, myalgias & peripheral edema; also exp SOB, fever, pleural effusion, hypoxemia, & renal insufficienty; hypoxemia, pleural effusions, lung infiltrates; hypersensitivity reaction, pt still febrile;


VAERS ID: 44335 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-07-29
Onset:1992-08-05
   Days after vaccination:7
Submitted: 1992-08-07
   Days after onset:2
Entered: 1992-08-20
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328934 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 324940 / 2 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-08-07
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiac arrest on the evening of 5AUG92; ?SIDS-no cause found; 7AUG92 pt probably brain dead; 7AUG92 pt died @ hsop;


VAERS ID: 44384 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Texas  
Vaccinated:1992-07-28
Onset:1992-07-30
   Days after vaccination:2
Submitted: 1992-07-30
   Days after onset:0
Entered: 1992-08-21
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655R / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: viral gastroenteritis;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to hosp DOA just over 48 hrs post vax w/hx of some vomiting;


VAERS ID: 44385 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1992-07-31
Onset:1992-08-02
   Days after vaccination:2
Submitted: 1992-08-17
   Days after onset:15
Entered: 1992-08-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2G31010 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HK / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 328921 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-08-02
   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: Nystatin suspension
Current Illness: thrush
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: death


VAERS ID: 44481 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-05-22
Onset:1992-05-26
   Days after vaccination:4
Submitted: 1992-06-03
   Days after onset:8
Entered: 1992-08-24
   Days after submission:82
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0653B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Hypoxia, Lung disorder, Lymphadenopathy, Petechiae, Pulmonary oedema, Respiratory disorder
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9280

Write-up: autopsy results not back sudden infant death synd;


VAERS ID: 44505 (history)  
Form: Version 1.0  
Age: 41.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1992-08-08
Onset:1992-08-08
   Days after vaccination:0
Submitted: 1992-08-18
   Days after onset:10
Entered: 1992-08-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4908077 / UNK LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Apnoea, Cardiac arrest, Dyspnoea, Gastroenteritis, Pyrexia, Respiratory acidosis, Shock, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mevacor, Questran lite;
Current Illness:
Preexisting Conditions: CHOL/HDL 444/45 in past; 210/40 JUL91;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recvd Typhoid vax & 1630 hrs had chills, t102.4, abd pain & vomiting; about 2 hrs later had cardiac arrest & could not be resuscitated from ventricular fibrillation;


VAERS ID: 44529 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Maryland  
Vaccinated:1992-08-20
Onset:1992-08-21
   Days after vaccination:1
Submitted: 1992-08-21
   Days after onset:0
Entered: 1992-08-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 100382 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found dead in bed-7AM 21AUG92;


VAERS ID: 45016 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Virginia  
Vaccinated:1991-11-26
Onset:1991-12-02
   Days after vaccination:6
Submitted: 1992-07-23
   Days after onset:233
Entered: 1992-09-15
   Days after submission:54
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125HI / 1 - / -

Administered by: Military       Purchased by: Military
Symptoms: Crying, Sudden infant death syndrome
SMQs:, Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-02
   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-SIDS;
CDC Split Type:

Write-up: Pt had hoarse cry not many days p/shot; MD had given perfect hlth @ 6wk check-up; died of SIDS on 2DEC;


VAERS ID: 45018 (history)  
Form: Version 1.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:1992-08-08
Onset:1992-08-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (ACETONE INACTIVATED DRIED) / PFIZER/WYETH 4918084 / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Cardiac arrest, Chills, Pyrexia, Shock, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: 1992-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mevacor, Questran lite
Current Illness:
Preexisting Conditions: Hypercholesterolemia; @ unk time in past was 444 total (45 HDL); in mid 1991 was 210 total (40 HDL);
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd Typhoid vax about 1355, had fever 102.4 in next 2-3 hrs w/chills, abd pain & vomiting; At about 1830 collapsed w/no pulse; could not be resiscitated; six other receiving same vax had no more than usual mild reactions;


VAERS ID: 45052 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Missouri  
Vaccinated:1992-08-27
Onset:1992-08-27
   Days after vaccination:0
Submitted: 1992-09-08
   Days after onset:12
Entered: 1992-09-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322973 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0656A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of inguinal hernia, treated surgically;
Allergies:
Diagnostic Lab Data: Autopsy results pending;
CDC Split Type:

Write-up: Sudden infant death approx 3 hrs p/recvd DTP/OPV/HIB TITER; no response to full advanced cardiac life support;


VAERS ID: 45144 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Maryland  
Vaccinated:1992-08-28
Onset:1992-08-31
   Days after vaccination:3
Submitted: 1992-09-01
   Days after onset:1
Entered: 1992-09-17
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M600JA / 3 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-08-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: no prior signs or symptoms;


VAERS ID: 45145 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maryland  
Vaccinated:1992-08-26
Onset:1992-09-10
   Days after vaccination:15
Submitted: 1992-09-14
   Days after onset:4
Entered: 1992-09-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2M31091 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M600JA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 328919 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: 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: 1992-09-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nystatin
Current Illness: Thrush
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy;SIDS;
CDC Split Type:

Write-up: No prior signs or symptoms;


VAERS ID: 45230 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Rhode Island  
Vaccinated:1992-09-08
Onset:1992-09-12
   Days after vaccination:4
Submitted: 1992-09-14
   Days after onset:2
Entered: 1992-09-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 330912 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M225HL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06640 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: ?APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB on 8SEP92 - brought to hosp w/prelimary dx of SIDS on 12SEP92; mom stated no apparent ill effects from shots; pt heard crying a/ later in about 1 hr was found unresponsive;


VAERS ID: 45435 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1992-07-07
Onset:1992-07-10
   Days after vaccination:3
Submitted: 1992-09-16
   Days after onset:68
Entered: 1992-09-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31005 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314939 / 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: 1992-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: coroners exam-SIDS
CDC Split Type:

Write-up: SIDS on 10JUL92;


VAERS ID: 45812 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Illinois  
Vaccinated:1992-09-14
Onset:1992-09-17
   Days after vaccination:3
Submitted: 1992-09-17
   Days after onset:0
Entered: 1992-09-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HN / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-17
   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: prematurity, triplet gestation
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL9287

Write-up: pt noted by care giver to be blue & w/o respirations;


VAERS ID: 45813 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Michigan  
Vaccinated:1992-08-17
Onset:1992-09-20
   Days after vaccination:34
Submitted: 1992-09-21
   Days after onset:1
Entered: 1992-09-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1217B / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320948 / 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: 1992-09-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: grandma called 21SEP92 PM letting me know that infant died of crib death 20SEP92;


VAERS ID: 45836 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Alaska  
Vaccinated:1992-07-07
Onset:1992-07-22
   Days after vaccination:15
Submitted: 1992-08-25
   Days after onset:34
Entered: 1992-09-28
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326913 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1283T / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312918 / 2 MO / PO

Administered by: Public       Purchased by: Public
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: 1992-07-22
   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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AK92023

Write-up: pt recvd vax 7JUL92 & died of SIDS on 23JUL92; no hx of any adverse events following vax;


VAERS ID: 46020 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1992-09-22
Onset:0000-00-00
Submitted: 1992-10-01
Entered: 1992-10-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322914 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1062V / 2 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JD / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 324938 / 1 MO / PO

Administered by: Private       Purchased by: Public
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: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ? unk notified by CPS of pt''s death;


VAERS ID: 46022 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Dakota  
Vaccinated:1991-05-07
Onset:1991-05-07
   Days after vaccination:0
Submitted: 1992-09-28
   Days after onset:510
Entered: 1992-10-05
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Military       Purchased by: Military
Symptoms: Hypertonia, Lung disorder, Pain, Petechiae, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-17
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp rxn 7MAR91;~ ()~~~In Sibling
Other Medications: Lotion for dry skin & rash;
Current Illness: pt had a sl cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type:

Write-up: pt began having cramping & muscles contracting; appeared in pain; contacted medical advice told to give warm baths, massages to innoculated area & APAP; if not improved take to clinic 17MAY91;


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