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VAERS ID: 46023 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: Texas  
Vaccinated:1991-07-15
Onset:1991-07-23
   Days after vaccination:8
Submitted: 1992-06-15
   Days after onset:328
Entered: 1992-10-05
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283970 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M565FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06285 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Crying, Haematemesis, Hyperglycaemia, Pallor, Somnolence
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-07-25
   Days after onset: 2
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: allergy to milk, swelling of the brain, hemolytic uremic synd;
Allergies:
Diagnostic Lab Data: blood sugar 221; CBC nl;
CDC Split Type: TX92199

Write-up: 23JUL91 began vomiting blood, pale, lethargic was hospitalized; woke screaming like had never heard a/; pt died 25JUL91 10 days p/shots;


VAERS ID: 46153 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1992-06-16
Onset:0000-00-00
Submitted: 1992-07-19
Entered: 1992-10-13
   Days after submission:86
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654B / 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: 1992-06-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Tempra
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy findings SIDS;
CDC Split Type: TX92198

Write-up: pt died 5 days p/vax of SIDS;


VAERS ID: 46154 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1992-02-18
Onset:1992-03-16
   Days after vaccination:27
Submitted: 1992-10-02
   Days after onset:199
Entered: 1992-10-13
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M5070HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE were performed immed p/vax was given;
CDC Split Type: TX92201

Write-up: no evident signs of reaction post vax; pt died on 16MAR92 was reported a SIDS death;


VAERS ID: 46159 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1992-09-29
Onset:1992-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1992-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125JD / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 326976 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Myocarditis, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up:


VAERS ID: 46215 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:1992-09-04
Onset:1992-09-19
   Days after vaccination:15
Submitted: 1992-10-09
   Days after onset:20
Entered: 1992-10-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac failure, Cardiovascular disorder, Ventricular extrasystoles
SMQs:, Cardiac failure (narrow), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU922341

Write-up: Pt recvd Engerix-B approx 4SEP92 & 19-20SEP92 weekend had heart attack poss premature ventricular contraction; seen by MD adm to hosp on late Saturday evening 19SEP92; early Sunday morning was in cardiac failure;


VAERS ID: 46247 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:1988-11-15
Onset:1989-01-17
   Days after vaccination:63
Submitted: 1992-10-07
   Days after onset:1358
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 1108P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Influenza
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 924090030

Write-up: pt recvd flu vax & pt was 1 of 5 who devel influenza & died;


VAERS ID: 46248 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:1988-11-15
Onset:1989-01-17
   Days after vaccination:63
Submitted: 1992-10-07
   Days after onset:1358
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 1108P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Influenza
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 924090029

Write-up: pt recvd flu vax & was 1 of 5 who devel influenza & died;


VAERS ID: 46249 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:1988-11-15
Onset:1989-01-17
   Days after vaccination:63
Submitted: 1992-10-07
   Days after onset:1358
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 1108P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Influenza
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 924090028

Write-up: pt recvd flu vax & was 1 of 5 who devel influenza & died;


VAERS ID: 46250 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:1988-11-15
Onset:1989-01-17
   Days after vaccination:63
Submitted: 1992-10-07
   Days after onset:1358
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 1108P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Influenza
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 924090027

Write-up: pt recvd flu vax & was 1 of 5 pts who devel influenza & died;


VAERS ID: 46251 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:1988-11-15
Onset:1989-01-17
   Days after vaccination:63
Submitted: 1992-10-07
   Days after onset:1358
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 1108P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Influenza
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 924090026

Write-up: pt recvd flu vax & was 1 of 5 pts who devel influenza & died;


VAERS ID: 46275 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Colorado  
Vaccinated:1992-10-08
Onset:1992-10-09
   Days after vaccination:1
Submitted: 1992-10-13
   Days after onset:4
Entered: 1992-10-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668M / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Cardiac arrest, Lung disorder, Petechiae, 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), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy could find no cause & events; porbable SIDS;
CDC Split Type: CO9284

Write-up: pt was found dead p/nap time about 12PM 9OCT92; to ER by ambulance; resuscitation was not successful; pt was completely asymptomatic a/this;


VAERS ID: 46276 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Female  
Location: Texas  
Vaccinated:1992-10-07
Onset:1992-10-08
   Days after vaccination:1
Submitted: 1992-10-14
   Days after onset:6
Entered: 1992-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 338971 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Aphasia, Encephalopathy, Grand mal convulsion, Paralysis
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? 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, 6 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nasalide, Megace, Theophyllin, Digoxin, K Ce, Lasix, Coumadin, Iron, ALbuterol inhaler, Atrovent;
Current Illness: breast cancer w/metasitasis, CHF
Preexisting Conditions: organic brain synd, recurrent deep vein thrombosis & pulmonar-embolism;
Allergies:
Diagnostic Lab Data: neg head CT x 2; neg LP; THeophylline level + digoxin levels non toxic;
CDC Split Type:

Write-up: seizures, grand mal w/in 12 hrs of vax; diffuse encephalopathy w/bilateral lower extremities & rt upper extremities paresis, aphasia;


VAERS ID: 46277 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Ohio  
Vaccinated:1992-10-01
Onset:1992-10-04
   Days after vaccination:3
Submitted: 1992-10-07
   Days after onset:3
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 335929 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HJ / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: born 3 months early (EDC 15AUG92) RDS/BPD for 2 months;
Allergies:
Diagnostic Lab Data: autopsy pending per coroner''s office;
CDC Split Type:

Write-up: pt was brought to ER dead on arrival; initial cause of death was attributed to sudden infant death synd;


VAERS ID: 46348 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:1992-10-08
Onset:1992-10-10
   Days after vaccination:2
Submitted: 1992-10-20
   Days after onset:10
Entered: 1992-10-22
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1032A4 / 1 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-10-10
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU922485

Write-up: 8OCT92 recvd 1 dose of Engerix-B & 10OCT92 pt''s mom called reporting MD to report found pt in crib dead approx 830-930AM (sudden infant death synd?); pt taken to medical examiner, autopsy report pending;


VAERS ID: 46526 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:1992-10-12
Onset:1992-10-14
   Days after vaccination:2
Submitted: 1992-10-16
   Days after onset:2
Entered: 1992-10-28
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928234 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Cardiomegaly, Confusional state, Hypotension, Leukocytosis, Myocardial infarction, Pulmonary oedema, Vascular occlusion
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-10-16
   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: ~ ()~~~In patient
Other Medications:
Current Illness: following Hemodialysis
Preexisting Conditions: pt had chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892293001E

Write-up: pt recvd flu vax & devel sudden onset of hypotension, hypoglycemia & chills; pt suffered a cardiac arrest & was hospitalized & died;


VAERS ID: 46528 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:1992-10-06
Onset:1992-10-07
   Days after vaccination:1
Submitted: 1992-10-13
   Days after onset:6
Entered: 1992-10-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Atrial fibrillation, Dermatitis bullous, Hallucination, Herpes zoster, Hypertension, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892289001E

Write-up: Pt recvd flu vax the next evening devel a rash & some blisters on breasts & back; dx w/herpes zoster; tx Zovirax & DPH; also exp inc BP & hallucinations; adm to hosp 12OCT92;


VAERS ID: 46630 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1992-10-01
Onset:1992-10-08
   Days after vaccination:7
Submitted: 1992-10-20
   Days after onset:12
Entered: 1992-11-02
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 1036391D8 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Delirium, Dyspnoea, Haemorrhage, Lung disorder, Pneumonia, Respiratory disorder, Rhinitis
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-08
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: found cold, respiratory arrest during nap;


VAERS ID: 46704 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-10-08
   Days after onset:5
Entered: 1992-11-05
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


VAERS ID: 46705 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-05
   Days after vaccination:3
Submitted: 1992-10-08
   Days after onset:3
Entered: 1992-11-05
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       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: 1992-10-05
   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: n/s
Current Illness: n/s
Preexisting Conditions: surgery on facial sinus; brain stem infarct
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092015

Write-up: death is reported in a pt who recvd flu vax on 2OCT; pt died on 5OCT92 w/no final cause of death given; an autopsy was performed; coroner believed that pt died of CVA; pt had undergone facial sinus surgery 2 wks prior to death;


VAERS ID: 46787 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-10-08
   Days after onset:5
Entered: 1992-11-09
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       Purchased by: Other
Symptoms: Cardiovascular disorder, Electrocardiogram abnormal, Malaise, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: h/o heart disease
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092016

Write-up: Death & myocardial infarction are reported in pt who recvd flu vax on 2OCT92; 3OCT92 was not feeling well & went to ER; had MI (full EKG changes); pt had a classical heart attack & died;


VAERS ID: 46809 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Oregon  
Vaccinated:1992-09-22
Onset:1992-09-27
   Days after vaccination:5
Submitted: 1992-10-02
   Days after onset:5
Entered: 1992-11-09
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316915 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655A / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Atelectasis, Cardiac failure, Endocarditis, Infection, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Digoxin, Iron fero-sul, amoxicillin;
Current Illness:
Preexisting Conditions: persistent aortic murmur, s/p aritical aortic stenosis relieved by commisurotomy, anemia-persistent;
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OR9255

Write-up: No adverse event; probable aortic stenosis-autopsy pending;


VAERS ID: 46810 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Oregon  
Vaccinated:1992-09-22
Onset:0000-00-00
Submitted: 1992-10-01
Entered: 1992-11-09
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316915 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655A / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Cough, Diarrhoea, Hepatocellular damage, Lung disorder, Pulmonary oedema, Renal impairment, Sudden infant death syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-01
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: OR9256

Write-up: there was no signs & sx reported from mom-vax were given 22SEP92; pt died of presumed SIDS 1OCT92; the ME report stated asphyxiation;


VAERS ID: 46833 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Maryland  
Vaccinated:1980-08-25
Onset:1980-08-28
   Days after vaccination:3
Submitted: 1992-11-03
   Days after onset:4450
Entered: 1992-11-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Insomnia, 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: 1980-08-28
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SIDS
CDC Split Type:

Write-up: pt was rated 9.7 health & weight; pt was in excellent care; mom did not use alcohol or drugs of any kind; pt had never been ill, even a cold x/for the shots; pt was fretful the day he died & did not take naps;


VAERS ID: 46835 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1992-10-29
Onset:1992-10-30
   Days after vaccination:1
Submitted: 1992-11-02
   Days after onset:3
Entered: 1992-11-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 332999 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332963 / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Petechiae, 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 (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: number one DTP/OPV/HIB given 29OCT92 cardiac arrest (SIDS) 30OCT92;


VAERS ID: 47149 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-10-13
Onset:1992-10-24
   Days after vaccination:11
Submitted: 1992-10-30
   Days after onset:6
Entered: 1992-11-12
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928223 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Trazadone, Tedrol, Prosom, Buspar
Current Illness: chronic bronchitis-alzheimers
Preexisting Conditions: PCN, Novacaine-alzheimers
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 47189 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:1992-10-28
Onset:1992-11-03
   Days after vaccination:6
Submitted: 1992-11-09
   Days after onset:6
Entered: 1992-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Cough, Hypertension, Hypotension, Malaise, Muscle twitching, Respiratory disorder, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Prozac, Synthroid, Trental, Tylenol, ASA, Senokot, Mult vit, Dulcolax;
Current Illness: NONE
Preexisting Conditions: no allergies-CVA rt hemopoisis, mild depression, plural effusions''
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: laughing, talking & eating well 2NOV92; 3NOV92 wake & vomited BP 180/110, P 100; 550 became listless, BP 75/50, P diff to count; twitching


VAERS ID: 47190 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1992-10-27
Onset:1992-10-30
   Days after vaccination:3
Submitted: 1992-11-09
   Days after onset:10
Entered: 1992-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 230911 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M135JA / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0664D / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Asphyxia, Bronchitis, Haemorrhage, Lung disorder, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: stuffy nose-no infection noted
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed, reported as consistent w/SIDS (verbal report);
CDC Split Type:

Write-up: 3 days p/receiving vax, pt presented to ER as a probable SIDS;


VAERS ID: 47268 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:1992-10-23
Onset:1992-10-25
   Days after vaccination:2
Submitted: 1992-10-29
   Days after onset:4
Entered: 1992-11-16
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928215 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-25
   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:
Current Illness: NONE
Preexisting Conditions: hx of CAD & chronic debilitation;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had an acute myocardial infarction on 25OCT92; pt did not recover; long hx of cornary artery disease & chronic debilitation;


VAERS ID: 47308 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:1992-10-16
Onset:1992-10-17
   Days after vaccination:1
Submitted: 1992-11-13
   Days after onset:27
Entered: 1992-11-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928226 / UNK RA / IM

Administered by: Private       Purchased by: Unknown
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: Lasix, K-tab, Hydralazme
Current Illness:
Preexisting Conditions: hypertension, moderate carotid artery stenosis, lt venous insufficiency;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up:


VAERS ID: 47309 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-02
   Days after vaccination:0
Submitted: 1992-11-04
   Days after onset:2
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military       Purchased by: Military
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: 1992-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: could not breath went into full arrest;


VAERS ID: 47310 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-03
   Days after vaccination:1
Submitted: 1992-11-04
   Days after onset:1
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2F311704 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
   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: Insulin, Clinoril med, for hypertension;
Current Illness: diabetes/hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found on floor @ home in full arrest;


VAERS ID: 47336 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Montana  
Vaccinated:1992-11-09
Onset:0000-00-00
Submitted: 1992-11-12
Entered: 1992-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320908 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 330929 / 2 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Haemorrhage, Hepatic function abnormal, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (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), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-09
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: baby expired from SIDS;


VAERS ID: 47359 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1992-10-05
Onset:1992-10-08
   Days after vaccination:3
Submitted: 1992-10-28
   Days after onset:20
Entered: 1992-11-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326915 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M600JA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06J6C / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy dx SIDS; Autopsy report requested;
CDC Split Type: 920360701

Write-up: pt exp no reaction following DTP/HIB/OPV vax on 5OCT92; 8OCT92 pt was found dead; autopsy dx SIDS;


VAERS ID: 47375 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-10-29
Onset:1992-10-30
   Days after vaccination:1
Submitted: 1992-11-03
   Days after onset:4
Entered: 1992-11-20
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322914 / 1 RL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1158V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0661D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-30
   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: had had MD exam 2 days prior;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN92142

Write-up: DTP/OPV/HIB/HBV were given 29OCT92 2PM pt found dead 30OCT92 approx 9AM of apparent crib death;


VAERS ID: 47382 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:1989-01-01
Submitted: 1992-11-09
   Days after onset:1408
Entered: 1992-11-23
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Immune system disorder, Infection, Multiple sclerosis, Myasthenic syndrome, Myelitis, Neuropathy, Paralysis flaccid
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Optic nerve disorders (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4525

Write-up: pt recvd inject & 2 wks later devel flu-like synd w/leg weakness which cont as chronic condition; CDC contacted felt poss vax caused condition; pt devel disease like MS (auto immune type) & fulminating infect & died;


VAERS ID: 47460 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Montana  
Vaccinated:1992-10-13
Onset:1992-10-27
   Days after vaccination:14
Submitted: 1992-11-10
   Days after onset:14
Entered: 1992-11-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322915 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0055T / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Infection, Meningitis, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: URI-no temp
Preexisting Conditions: normal
Allergies:
Diagnostic Lab Data: lab tests completed @ hosp 27OCT92;
CDC Split Type: MT92027

Write-up: pt was admitted to hosp on 27OCT92 for pneumonia began to devel resp problems & was transferred to another hosp on 27OCT92; dx Haemophilus Influenza meningitis & died 27OCT92;


VAERS ID: 47474 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Female  
Location: Maine  
Vaccinated:1992-11-05
Onset:0000-00-00
Submitted: 1992-11-09
Entered: 1992-11-25
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928115 / UNK - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Endocarditis, Influenza, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: hodgkins disease/asplenic
Preexisting Conditions: pt had hodgkins disease & is asplenic;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892315007E

Write-up: pt recvd flu vax & devel flu-like sx; the following morning pt collapsed & was adm to the hosp; pt is on a respirator & is critically ill;


VAERS ID: 47492 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-11-12
   Days after onset:40
Entered: 1992-11-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: PA92327

Write-up: 3OCT92 seen in Er admitted to hosp;


VAERS ID: 47493 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-11-12
   Days after onset:40
Entered: 1992-11-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: PA92328

Write-up: pt seen in ER where died 3OCT92;


VAERS ID: 47507 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-11-05
Onset:1992-11-09
   Days after vaccination:4
Submitted: 1992-11-09
   Days after onset:0
Entered: 1992-11-30
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312933 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal distension, Atelectasis, Bronchitis, Haemorrhage, Infection, Pulmonary haemorrhage, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: healthy
Preexisting Conditions: full-term vaginal delivery
Allergies:
Diagnostic Lab Data: unk if autopsy has been performed;
CDC Split Type: 920372301

Write-up: pt recvd DTP/HBOC/OPV on 5NOV92; exp no local or systemic reactions; pt found dead 4 days later 9NOV92; pronounced dead on arrival in ER: No known risk factors for SIDS; tentative dx SIDS;


VAERS ID: 47526 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Wisconsin  
Vaccinated:1992-05-07
Onset:1992-05-09
   Days after vaccination:2
Submitted: 1992-07-07
   Days after onset:59
Entered: 1992-11-30
   Days after submission:146
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M665HH / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703T / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-21
   Days after onset: 12
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: mom knows lab work done-unsure what tests;
CDC Split Type: WI92054

Write-up: diarrhea, vomiting; rash tha came & went around neck & diaper area; tired; no blood in stool; poor appetite; no headache; no seizures; seen by MD:


VAERS ID: 47657 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1992-05-22
Onset:1992-06-16
   Days after vaccination:25
Submitted: 1992-09-10
   Days after onset:86
Entered: 1992-12-03
   Days after submission:84
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322915 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0656C / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: congenital defect
Preexisting Conditions: cleft lip & palate;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS9245

Write-up: mom found pt in crib morning of 16JUN92 not breathing-says had not been ill was seeing MD frequently due to cleft lip & palate;


VAERS ID: 47661 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Mississippi  
Vaccinated:1992-09-25
Onset:1992-09-26
   Days after vaccination:1
Submitted: 1992-09-29
   Days after onset:3
Entered: 1992-12-03
   Days after submission:65
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 330910 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HN / 3 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Bronchitis, Lung disorder, Oesophagitis, Petechiae, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific inflammation (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS9249

Write-up: pt recvd DTP/HIB 25SEP92 around 9AM; mom reports giving APAP aobut 11PM & pt going to sleep around 12AM; pt awoke 2, 4, & 430AM; parents awoke 830-9AM pt was not breathing; Father reports secretions from pts mouth; family called coroner;


VAERS ID: 47663 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-08-20
Onset:1992-08-31
   Days after vaccination:11
Submitted: 1992-09-30
   Days after onset:30
Entered: 1992-12-03
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 330910 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0011V / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 329960 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Coma, Convulsion, Headache, Neck pain, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), 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, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: spinal tap, blood culture, EEG, x-rays, Brain scan;
CDC Split Type: MS9251

Write-up: 31AUG92 pt spiked t103 & c/o h/a & sore neck; was taken to hosp & treated w/PCN & phenergan & sent home; 1SEP92 pt had seizure & was taken to hosp adm to hosp 1SEP92; pt has been in coma since 1SEP92;


VAERS ID: 47668 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-10-09
Onset:1992-10-21
   Days after vaccination:12
Submitted: 1992-10-26
   Days after onset:5
Entered: 1992-12-03
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS9256

Write-up: pt had massive coronary & died on 21OCT92;


VAERS ID: 47818 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1992-09-24
Onset:1992-09-28
   Days after vaccination:4
Submitted: 1992-12-02
   Days after onset:65
Entered: 1992-12-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326914 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Enteritis, Hepatocellular damage, Laryngeal oedema, Lymphadenopathy, Petechiae, Respiratory disorder, Spleen disorder, Sudden infant death syndrome
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific inflammation (narrow), Neonatal disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: small for gestational age
Allergies:
Diagnostic Lab Data: autopsy ruled out other causes of death;
CDC Split Type:

Write-up: died SIDS 4 days p/vax;


VAERS ID: 47851 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1992-10-19
Onset:0000-00-00
Submitted: 1992-11-30
Entered: 1992-12-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M135JA / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 324937 / 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: 1992-11-12
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: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA92127

Write-up: SIDS on death certificate; not reported by family-PHN remembered giving vax; no known SE from vax;


VAERS ID: 47857 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-11-05
Onset:1992-11-05
   Days after vaccination:0
Submitted: 1992-12-07
   Days after onset:32
Entered: 1992-12-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 335914 / 1 - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0100V / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiovascular disorder, Hyperhidrosis, Hypertrophy, Malaise, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-05
   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:
Current Illness:
Preexisting Conditions: COPD, end stage; hyperlimpidemia; hypertension
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES92111093

Write-up: pt recvd vax & approx 9 hrs following vax pt devel sweating & did not feel well; pts husband suggested ER but pt did not; pt died @ home;


VAERS ID: 47866 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:1992-11-11
Onset:1992-11-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1992-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found apneic & blue; CPR started; paramedics took to ER; no response to ACLS; ?aspiration, SIDS, ?reaction to DTP;


VAERS ID: 48042 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:1992-10-06
Onset:0000-00-00
Submitted: 1992-10-11
Entered: 1992-12-14
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2M31091 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 330929 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-07
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: MN92046

Write-up:


VAERS ID: 48154 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Minnesota  
Vaccinated:1992-11-24
Onset:1992-11-25
   Days after vaccination:1
Submitted: 1992-12-08
   Days after onset:13
Entered: 1992-12-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2M31091 / 2 - / -
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: Apnoea, Cardiac arrest, Cyanosis, Hypothermia, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Accidents and injuries (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4565

Write-up: SIDS; well visit; no illness @ time of exam; @ sitter''s found around noon cold & blue; CPR started & taken to ER: autopsy results consistent w/SIDS:


VAERS ID: 48214 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1992-12-15
Entered: 1992-12-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4603

Write-up: probable SIDS;


VAERS ID: 48330 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Georgia  
Vaccinated:1992-03-26
Onset:0000-00-00
Submitted: 1992-04-15
Entered: 1992-12-23
   Days after submission:252
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320908 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HJ / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0637D / 2 MO / PO

Administered by: Public       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: 1992-04-08
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: death cert lists cause of death as cardiac pul failure to sids
CDC Split Type: GA92122

Write-up: 8Apr92 Coroner called stating pt was found dead by mom this am. Her body is being sent to state crime lab for autopsy.1Jun92 death cert list cause of death : cardiac pul failure D/T to sids


VAERS ID: 48399 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1992-09-01
Onset:0000-00-00
Submitted: 1992-09-16
Entered: 1992-12-23
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328932 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 695HL / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654M / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiac arrest, Cyst, Petechiae, Pyrexia, 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 (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-04
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: post mortem report 4SEP92 pending;
CDC Split Type: GA92194

Write-up: 11SEP92 death reported by MD pt DOA ER 430PM on 4SEP92; autopsy findings lung petechiae - SIDS; no other abnormal findings; pt was fussy & had fever; pt noted not breathing; CPR initiated;


VAERS ID: 48401 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1992-06-30
Onset:1992-07-16
   Days after vaccination:16
Submitted: 1992-09-22
   Days after onset:68
Entered: 1992-12-23
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320908 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0651E / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Haemorrhage, Lung disorder, Pulmonary haemorrhage, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA92196

Write-up: SIDS death 16JUL92; petechial hemmorrhages; pulmonary parenchyma is dark red-purple, deeply congested & exudes large amounts of bloody frothy fluid on sectioning; autopsy dx generalized visceral congestion;


VAERS ID: 48415 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:1992-10-08
Onset:1992-10-12
   Days after vaccination:4
Submitted: 1992-10-15
   Days after onset:3
Entered: 1992-12-23
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928243 / 3 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Myocardial infarction, Nausea, Shock
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Myocardial infarction (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), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: hx of coronary problems
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA92210

Write-up: 930AM 12OCT92 MD office w/nausea, weak; hx of heart disease; BP 162/50-sent ot ER expired 1152 12OCT92 w/prob dx of myocardial infarction;


VAERS ID: 48611 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1992-08-05
Onset:1992-08-07
   Days after vaccination:2
Submitted: 1992-08-18
   Days after onset:11
Entered: 1993-01-04
   Days after submission:139
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1218A / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 7+ LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 657C2 / 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: 1992-08-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy neg;
CDC Split Type: MI92124

Write-up: SIDS:


VAERS ID: 48672 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1992-10-29
Onset:1992-11-22
   Days after vaccination:24
Submitted: 1992-11-30
   Days after onset:8
Entered: 1993-01-04
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Anxiety, Cardiac arrest, Condition aggravated, Dyspnoea, Hypertension, Hyperventilation, Myocardial infarction, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, Lanoxin, Calan SR, Humulin, Axid, Nitrobid, Elavil, Nifedipineoth
Current Illness: NONE
Preexisting Conditions: CAD, IDDM, Hypertension, chronic CHF, cardiomegaly;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WV9242

Write-up: dyspnea, anxiety, P56, R36, BP 200/90, 02 on transferred to hosp; causes of death-cardiac failure, CHF, Ischemic cardiomyopathy, COPD; also exp discomfort & tingling in arms; R36 shallow & labored;


VAERS ID: 48675 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1992-11-19
Onset:1992-11-26
   Days after vaccination:7
Submitted: 1992-12-09
   Days after onset:13
Entered: 1993-01-04
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 332999 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 334948 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-26
   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:
CDC Split Type:

Write-up: SIDS;


VAERS ID: 48676 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Arizona  
Vaccinated:1992-12-09
Onset:1992-12-15
   Days after vaccination:6
Submitted: 1992-12-18
   Days after onset:3
Entered: 1993-01-04
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326983 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JA / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 330938 / UNK MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Cardiac arrest, Haemorrhage, Lung disorder, Pallor, Petechiae, Pulmonary oedema
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reporter recvd call from another hosp pt arrived DOA 15DEC92; reporter does not know of specific cause of death or any recent sx pt may have demonstrated; <7 days since DTP;


VAERS ID: 48677 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maryland  
Vaccinated:1992-12-22
Onset:1992-12-25
   Days after vaccination:3
Submitted: 1992-12-30
   Days after onset:5
Entered: 1993-01-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 332985 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1076A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125JD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 336922 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Eosinophilia, Haemorrhage, Infection, Pneumonia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-25
   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: ?URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy-ME
CDC Split Type:

Write-up: pt had a fatal sids on 25DEC92 @ 840AM; this is being reported only because of the time sequence to vax administration 22DEC92;


VAERS ID: 48753 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1992-12-28
Onset:1993-01-02
   Days after vaccination:5
Submitted: 1993-01-06
   Days after onset:4
Entered: 1993-01-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M020JE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332972 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-01-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: sudden infant death synd died 2JAN93;


VAERS ID: 48834 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Texas  
Vaccinated:1992-11-27
Onset:1992-11-28
   Days after vaccination:1
Submitted: 1993-01-04
   Days after onset:37
Entered: 1993-01-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 334981 / 3 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005JE / 3 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0669A / 3 MO / PO

Administered by: Military       Purchased by: Military
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypotonia, Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Rondec
Current Illness: mild UR w/o fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy findings c/w SIDS;
CDC Split Type:

Write-up: pt put in crib on side @ 0500 alert, awake, afebrile, seemingly in good condition found by family 0900 blue, limp, no resp & no heart rate-resuscitation unsuccessful; (intrathoracic petechia lungs w/interstitial congestion)


VAERS ID: 49035 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-12-17
Onset:1992-12-21
   Days after vaccination:4
Submitted: 1992-12-29
   Days after onset:8
Entered: 1993-01-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0420V / 2 RL / -

Administered by: Public       Purchased by: Unknown
Symptoms: Cerebral haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-21
   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: seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS9270

Write-up: pt died on 21DEC92 recvd vax on 17DEC92; autopsy showed cerebral hemmorhage, cause of death;


VAERS ID: 49057 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:1992-10-21
Onset:1992-11-07
   Days after vaccination:17
Submitted: 1992-11-23
   Days after onset:16
Entered: 1993-01-14
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Haemorrhage, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC Split Type: 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


VAERS ID: 49099 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Connecticut  
Vaccinated:1993-01-05
Onset:1993-01-08
   Days after vaccination:3
Submitted: 1993-01-12
   Days after onset:4
Entered: 1993-01-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 334931 / 1 - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0573V / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332965 / 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: 1993-01-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pt recvd Hep B vax 8DEC92 lot# 1161V;
Current Illness: NONE
Preexisting Conditions: premature (34w) intrauterine growth retardation
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: sudden death (?sids) 3 days p/DTP/OPV/HIB-no fever or any other sx following immun; autopsy done-results pending;


VAERS ID: 49314 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-12-28
Onset:1993-01-02
   Days after vaccination:5
Submitted: 1993-01-06
   Days after onset:4
Entered: 1993-01-25
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2B41152 / 1 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JD / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332973 / 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: 1993-01-02
   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: autopsy will be done;
CDC Split Type: SD93003

Write-up: pt died SIDS?; father an EMT administered CPR:


VAERS ID: 49316 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-12-18
Onset:1992-12-24
   Days after vaccination:6
Submitted: 1992-12-29
   Days after onset:5
Entered: 1993-01-25
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1160V / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0661D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Coma, Petechiae, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: pt born 4 wks premature; however birth wt 6# 8 oz
Allergies:
Diagnostic Lab Data: autopsy results unk @ this time;
CDC Split Type: TN92169

Write-up: mom found pt unconscious-unable to resuscitate-dx probable SIDS;


VAERS ID: 49549 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Texas  
Vaccinated:1979-03-29
Onset:1979-04-09
   Days after vaccination:11
Submitted: 1993-01-04
   Days after onset:5019
Entered: 1993-02-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Military       Purchased by: Military
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1979-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2 other siblings SIDS in family~ ()~~~In Sibling
Other Medications: NA
Current Illness:
Preexisting Conditions: pt was product of nl pregnancy; family was stationed in the air force @ time of event; parents have 1 child who recvd vax w/o problems;
Allergies:
Diagnostic Lab Data: autopsy dx: SIDS:
CDC Split Type: 930001601

Write-up: Consulting MD reported 3 deaths which occurred in a particular family over a 5 yr period following 1st DTP vax; autopsy dx SIDS in all 3 infants; 1 of 3 pts vaxed 54 days of age was found dead in bed in early AM 11 days p/vax in 1979;


VAERS ID: 49550 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Ohio  
Vaccinated:1982-06-18
Onset:1982-06-26
   Days after vaccination:8
Submitted: 1993-01-04
   Days after onset:3845
Entered: 1993-02-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1982-06-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2 other siblings SIDS in family~ ()~~~In Sibling
Other Medications: NA
Current Illness:
Preexisting Conditions: pt was product of nl pregnancy; family was stationed in the air force @ time of event; parents have 1 child who recvd vax w/o problems;
Allergies:
Diagnostic Lab Data: Autopsy dx: SIDS;
CDC Split Type: 930001602

Write-up: consulting MD reported 3 deaths which occurred in a particular family over a 5 yr period following 1st DTP vax; autopsy dx SIDS in all 3 pts; 1 of the 3 pts was vaxed @ 50 days of age was found dead in bed 8 days p/vax in 1982;


VAERS ID: 49551 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Nevada  
Vaccinated:1984-02-01
Onset:1984-02-14
   Days after vaccination:13
Submitted: 1993-01-04
   Days after onset:3247
Entered: 1993-02-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1984-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2 other sibling SIDS in family;~ ()~~~In Sibling
Other Medications: NA
Current Illness:
Preexisting Conditions: pt was product of nl pregnancy; family was stationed in the air force @ time of event; parents have 1 child who recvd vax w/o problems;
Allergies:
Diagnostic Lab Data: Autopsy dx: SIDS;
CDC Split Type: 930001603

Write-up: consulting MD reported 3 deaths which occured in a particular family over a 5 yr period following 1st/DTP vax; autopsy dx SIDS in all 3 pts; 1 of the 3 pts who was vax @ 71 days of age was found dead in bed 7AM 13 dasy p/vax in 1984;


VAERS ID: 49552 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Unknown  
Vaccinated:1992-12-08
Onset:1993-01-07
   Days after vaccination:30
Submitted: 1993-01-11
   Days after onset:4
Entered: 1993-02-01
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 0716 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy infant
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: family refused an autopsy; post-mortem BC & nasopharyngeal, Swab for B. pertussis performed results pending;
CDC Split Type: 930006801

Write-up: clinical trial report stated pt recvd DTP on 27OCT92 & 8DEC92 seen by investigator on 5JAN92 dx obstructive bronchitis; tx w/ATB, bronchiodilator, secretolytic w/apparent improvement; parents found pt dead in bed 7JAN93 @ 730AM;


VAERS ID: 49570 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Kansas  
Vaccinated:1986-11-24
Onset:1986-11-24
   Days after vaccination:0
Submitted: 1993-01-27
   Days after onset:2256
Entered: 1993-02-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6A81077 / 4 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1986-11-26
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death occurred w/in 34 hrs of 4th DTP vax;


VAERS ID: 49592 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Massachusetts  
Vaccinated:1993-01-20
Onset:1993-01-21
   Days after vaccination:1
Submitted: 1993-01-27
   Days after onset:6
Entered: 1993-02-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP281 / 2 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M600JA / 2 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0659H / 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: 1993-01-21
   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: MA9313

Write-up: died of SIDS on 21JAN93;


VAERS ID: 49699 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1992-12-22
Onset:1992-12-23
   Days after vaccination:1
Submitted: 1992-12-23
   Days after onset:0
Entered: 1993-02-08
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41103 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Ecchymosis, 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: 1992-12-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: GA92241

Write-up: pt recvd vax 22DEC92 & mom stated when dad went to work pt was fine; 9AM pt was face down & dead; mom took pt to ER & CPR was done but pt did not recover;


VAERS ID: 49702 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1992-11-30
Onset:1992-12-01
   Days after vaccination:1
Submitted: 1992-12-11
   Days after onset:10
Entered: 1993-02-08
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2M31091 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Pneumonia, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA92244

Write-up: 1DEC92 clinic reported pt was found dead that day & that shots had been given @ the clinic on the day a/;


VAERS ID: 49707 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1992-11-19
Onset:0000-00-00
Submitted: 1992-12-01
Entered: 1993-02-08
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326915 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654M / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Hepatomegaly, Lung disorder, Splenomegaly, Sudden infant death syndrome
SMQs:, Liver related investigations, signs and symptoms (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA92249

Write-up:


VAERS ID: 49709 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1992-12-08
Onset:1992-12-13
   Days after vaccination:5
Submitted: 1992-12-29
   Days after onset:16
Entered: 1993-02-08
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326915 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654M / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: hosp 1 wk prior w/bronchitis
Preexisting Conditions: bronchitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA92251

Write-up:


VAERS ID: 49902 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1992-12-29
Onset:1993-01-10
   Days after vaccination:12
Submitted: 1993-02-09
   Days after onset:30
Entered: 1993-02-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 330932 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 2 RL / IM

Administered by: Other       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: 1993-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: ampicillin allergy described as a rash;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt suffered cardiopulmonary arrest @ home while aware 11 days p/clinc visit for hlth supervisior; pt asymptomatic prior to occurence; autopsy listed cause of death as SIDS;


VAERS ID: 49950 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1992-12-01
Onset:1992-12-02
   Days after vaccination:1
Submitted: 1993-01-15
   Days after onset:44
Entered: 1993-02-17
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 326964 / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657M / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: microcephaly;blind
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC93003

Write-up: MD says pt has been severly handicapped since birth & vax was not the cause of death;


VAERS ID: 49953 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-06-05
Onset:1992-06-15
   Days after vaccination:10
Submitted: 1993-01-05
   Days after onset:204
Entered: 1993-02-17
   Days after submission:43
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314957 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M18HH / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0653F / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Lymphadenopathy, Stupor, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC93006

Write-up: pt expired (SIDS) on 15JUN92; pt did not awaken from afternoon nap; pt was not ill;


VAERS ID: 50056 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New York  
Vaccinated:1993-01-20
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1993-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 233812 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-01-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt died of crib death on 24JAN92; coroner exam not remarkable-reported as SIDS;


VAERS ID: 50086 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1992-11-30
Entered: 1993-02-18
   Days after submission:80
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928231 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893022001E

Write-up: pt recvd flu vax & 5 mins later pt died; Wyeth is awaiting f/u info;


VAERS ID: 50401 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alabama  
Vaccinated:1993-02-09
Onset:0000-00-00
Submitted: 1993-02-17
Entered: 1993-03-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338921 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ferrous Sulfate
Current Illness: NONE
Preexisting Conditions: anemia
Allergies:
Diagnostic Lab Data: dx SIDS by coroner;
CDC Split Type: AL93007

Write-up: mom states pt had fever day of vax; APAP was given; denies any adverse sx or events; states pt was well in good health;


VAERS ID: 50420 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kansas  
Vaccinated:1993-02-02
Onset:1993-02-04
   Days after vaccination:2
Submitted: 1993-02-09
   Days after onset:5
Entered: 1993-03-01
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 331913 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0670B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Haemorrhage, Nervousness, Petechiae, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-04
   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: Rondec drops
Current Illness: 2FEB93 pt mom siad pt had cold & take AP
Preexisting Conditions: last seen by MD 12JAN93; potential apneic condition; prev suspicious apneic episode described by mom to MD;
Allergies:
Diagnostic Lab Data: MD said a pneumogram had been ordered but not done adequately because the apnea monitor was not on long enough;
CDC Split Type: KS93003

Write-up: pt MD said pt discovered dead by parents on 4FEB93 & that apparently is a SIDS death; MD said that the parents had an apnea monitor @ home but it was not used;


VAERS ID: 50453 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Virginia  
Vaccinated:1993-01-14
Onset:1993-01-15
   Days after vaccination:1
Submitted: 1993-01-15
   Days after onset:0
Entered: 1993-03-02
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 334931 / 3 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195JF / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Bronchitis, Lung disorder, Petechiae, 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: 1993-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Healthy;
Preexisting Conditions: doses 1 & 2 (DTP/HOBC) were administered by a pvt MD
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: 930015301

Write-up: pt recvd DTP/HOBC on 14JAN93 & w/in 12 hrs p/vax, pt was found dead @ home; transported byEMTto local hospital & pronounced dead on arrival; autopsy scheduled;


VAERS ID: 50554 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Florida  
Vaccinated:1993-02-26
Onset:1993-03-03
   Days after vaccination:5
Submitted: 1993-03-04
   Days after onset:1
Entered: 1993-03-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342970 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105JJ / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338934 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: No illness
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: mom states put to bed aprox 8PM 2MAR93 & found lifeless @ around 6AM 3MAR93 EMS called;


VAERS ID: 51042 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Female  
Location: Maryland  
Vaccinated:1992-04-29
Onset:1992-05-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1993-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 4 - / -

Administered by: Other       Purchased by: Other
Symptoms: Angiopathy, Arthralgia, Collagen disorder, Infection, Myalgia, Sepsis, Thrombocytopenia, Vasculitis
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-31
   Days after onset: 25
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MAY92 WBC Count 2.1; Platelet count 40,000; Biopsy rash-lymphocytic infiltration;
CDC Split Type: WAES92050484

Write-up: Pt recvd 4th doses of Hep B vax on 3MAY92 devel fever of 104 to 105.7 & a rash described as macular, papular; 4MAY92 hospitalized due to persistance of sx; had a dec WBC & platelet count; Rocky Mountain spotted fever or meningococcemia;


VAERS ID: 52844 (history)  
Form: Version 1.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:1992-10-14
Onset:1992-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1993-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0788V / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension; Bronchitis, chronic; substance abuse
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES92110935

Write-up: Pt recvd vax 14OCT92 & died;


VAERS ID: 52863 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:1992-10-30
Submitted: 0000-00-00
Entered: 1993-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1246T / 3 - / -

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Arthritis, Diplopia, Meningitis, Paraesthesia, Pseudo lymphoma, Thrombocythaemia
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Ocular motility disorders (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Moduretic, Estrace, Decadron, Tylenol, Zantac;
Current Illness:
Preexisting Conditions: obese, sinus infection, alcohol abuse; medical hx: hypertension, rectal herpes, D&C, appendectomy, smoker, tonsillectomy, rectal fistula;
Allergies:
Diagnostic Lab Data: 4NOV92 WBC Count 12.6; Platelet coung 460; Neutrophils 6; Rheumatoid workup neg;
CDC Split Type: WAES92110959

Write-up: pt recvd vax & 2 wks following vax exp severe joint pain & dizziness; consulted a physician; lab eval 4NOV92 revealed ESR of 32mm hr, WBC count 12.6, platelet count of 460, neutrophils 6 & neg RA titer; knee pain & mild effusion; pain


VAERS ID: 50585 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: D.C.  
Vaccinated:1993-01-07
Onset:1993-01-20
   Days after vaccination:13
Submitted: 1993-02-09
   Days after onset:20
Entered: 1993-03-09
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326982 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M109HK / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 330934 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-09
   Days after onset: 20
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK; 1 of 3 pts vaxed, since SEP92 in this pract who devel pneumonia or chest congestion & fever; reporting MD questions receipt of orange OPV;
Allergies:
Diagnostic Lab Data: CXR;
CDC Split Type: 930036901

Write-up: pt recvd vax 7JAN93 & office visit on 20JAN for cold sx & fever 101; cxr revealed pneumonia; tx w/Rocephin/Ceclor/Ventolin; Office visit 2FEB; taken to ER on 9FEB-dead on arrival; cause of death not currently available;


VAERS ID: 50678 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Oklahoma  
Vaccinated:1993-02-11
Onset:1993-02-18
   Days after vaccination:7
Submitted: 1993-03-04
   Days after onset:14
Entered: 1993-03-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0804V / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0665F / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Dyspnoea, Hepatic steatosis, Pulmonary oedema, Pyrexia, Red blood cell abnormality, Vomiting
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: rash & URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OK936

Write-up: collapsed on 18FEB93-no prior sx;


VAERS ID: 50679 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oklahoma  
Vaccinated:1993-02-24
Onset:1993-02-24
   Days after vaccination:0
Submitted: 1993-03-05
   Days after onset:9
Entered: 1993-03-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332973 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Rash, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Mylicon GTTSs, APAP GTTs;
Current Illness: RB Gassiness
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OK937

Write-up: pt died during the noc p/1st set of immun were given @ clinic that day; exaxt time of death unk;


VAERS ID: 50680 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oklahoma  
Vaccinated:1993-02-16
Onset:1993-03-06
   Days after vaccination:18
Submitted: 1993-03-08
   Days after onset:2
Entered: 1993-03-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0665F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: coryza & diaper rash;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OK938

Write-up: no previous signs or sx; died in sleep; arrived @ hosp ER 825 & was pronounced dead;


VAERS ID: 50682 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1971-11-15
Onset:1971-11-15
   Days after vaccination:0
Submitted: 1993-02-26
   Days after onset:7774
Entered: 1993-03-11
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Crying, Oedema, Petechiae, Screaming, Skin nodule, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1971-11-24
   Days after onset: 9
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: died 24NOV71;
CDC Split Type:

Write-up: From the time of the shot until death 9 day later pt screamed & little butt swelled the size of a soft ball & hard as a rock; mom thinks pt died as result of shot not crib death as stated by hosp & MD:


VAERS ID: 50757 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1992-12-16
Onset:1992-12-24
   Days after vaccination:8
Submitted: 1993-03-04
   Days after onset:70
Entered: 1993-03-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 332986 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0658B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Bronchitis, Haemorrhage, Infection, Lung disorder, Petechiae, Pulmonary oedema, Pyrexia, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: HCT 35%;
CDC Split Type: FL93011

Write-up: unable to document an adverse effects pt died of SIDS 24DEC92 vaxed 16DEC92;


VAERS ID: 50758 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Louisiana  
Vaccinated:1993-02-15
Onset:1993-02-16
   Days after vaccination:1
Submitted: 1993-02-26
   Days after onset:10
Entered: 1993-03-15
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 LL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1147V / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0665A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Atelectasis, Cardiac arrest, Cardiomegaly, Cyanosis, Mydriasis, Petechiae, Respiratory disorder, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), 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 (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: resting sinus tachycardia HRIGO-170, 31 wk gest premie;
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA930301

Write-up: Pt born premature w/hx cocaine & syphillis during preg; seen 15DEC in clinc nl exam x/for HR 160-170 sinus rhythm; referred for EKG, CXR; next am doing well but 5HR in crib sids & enlarged heart, aspiration, not moving, CPR, no heart beat;


VAERS ID: 50791 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: California  
Vaccinated:1993-02-24
Onset:1993-02-25
   Days after vaccination:1
Submitted: 1993-03-09
   Days after onset:12
Entered: 1993-03-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E4107 / 4 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035JH / 4 - / -

Administered by: Public       Purchased by: Private
Symptoms: Condition aggravated, Dementia, Neonatal disorder
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: cocaine exposure, severe asphyxia; 30OCT92 sz disorder;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt in for vax;


VAERS ID: 50793 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-08-27
Onset:1991-09-03
   Days after vaccination:7
Submitted: 1993-03-07
   Days after onset:551
Entered: 1993-03-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Coma, Convulsion, Encephalitis, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: poss of asthma (allergy to cats)
Allergies:
Diagnostic Lab Data: autopsy report concluded that pt died of post vaccinal encephalitis;
CDC Split Type:

Write-up: severe h/a 3SEP91 AM-PM; vomiting p/MN; seizures 7AM on 4SEP91; coma-death 1225PM on 4SEP91;


VAERS ID: 50878 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1993-03-03
Onset:1993-03-04
   Days after vaccination:1
Submitted: 1993-03-10
   Days after onset:6
Entered: 1993-03-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2C41012 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M490JK / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0670D / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-04
   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: Luride
Current Illness: acute gastroenteritis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: preliminary cause of death-SIDS;
CDC Split Type:

Write-up: pt found dead approx 28 hrs p/vax;


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