|
VAERS ID: |
26318 (history) |
Form: |
Version 1.0 |
Age: |
92.0 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: | 1990-10-09 |
Onset: | 1990-10-11 |
Days after vaccination: | 2 |
Submitted: |
1990-10-17 |
Days after onset: | 6 |
Entered: |
1990-10-22 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11216 / 1 |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-12
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet Current Illness: Rt lacunar Infarct Temp Area, Hypertens. Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke Allergies: Diagnostic Lab Data: All lab work WNL CDC Split Type:
Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90. |
|
VAERS ID: |
26336 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-07-26 |
Onset: | 1990-07-29 |
Days after vaccination: | 3 |
Submitted: |
1990-10-23 |
Days after onset: | 86 |
Entered: |
1990-10-25 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0603D / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Agitation,
Pyrexia,
Sudden infant death syndrome SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-07-29
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS. CDC Split Type:
Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3. |
|
VAERS ID: |
26483 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Unknown |
Location: |
Connecticut |
Vaccinated: | 1989-07-27 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
244984 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
250939 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Hypertonia,
Insomnia,
Screaming,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-04-18
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: 900157501
Write-up: Pt vaccinated with 1st DTP/OPV on 27Jul89, developed loss of head control, screaming & vomiting, had sleep loss, limbs tense and developed seizures. Hospitalized many times between Sep-Dec89, received DT, condition worsened; Died 18APR90. |
|
VAERS ID: |
26463 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1990-10-01 |
Onset: | 1990-10-01 |
Days after vaccination: | 0 |
Submitted: |
1990-10-17 |
Days after onset: | 16 |
Entered: |
1990-11-02 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908209 / UNK |
LA / IM |
Administered by: Private Purchased by: Other Symptoms: Apnoea,
Atelectasis,
Hypoventilation,
Influenza,
Pneumonia,
Pyrexia,
Rhinitis SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-16
Days after onset: 15
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 SPECIFIED Current Illness: CANCER Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR Allergies: Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM CDC Split Type: 890291001B
Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX |
|
VAERS ID: |
26484 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-09-27 |
Onset: | 0000-00-00 |
Submitted: |
1990-10-30 |
Entered: |
1990-11-05 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / 4 |
- / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Agitation,
Apnoea,
Cardiac arrest,
Chills,
Pain,
Pyrexia,
Vasodilatation SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-06
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/HIB/MMR found apneic in crib on 06OCT90. |
|
VAERS ID: |
26592 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 1990-10-03 |
Onset: | 1990-10-26 |
Days after vaccination: | 23 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11070 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 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: Estrace Cream Current Illness: Preexisting Conditions: Premature birth 2lbs 13 oz Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type:
Write-up: Pt vaccinated with PROHIBIT DOA to Hosp. |
|
VAERS ID: |
26593 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-10-29 |
Onset: | 1990-10-31 |
Days after vaccination: | 2 |
Submitted: |
1990-11-02 |
Days after onset: | 2 |
Entered: |
1990-11-08 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0G11097 / UNK |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-31
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Nystatin Ointment Current Illness: Diaper Rash Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV no adverse effects according to father; Pt was fine the day after immunization. Pt discovered not breathing at 2AM 31OCT. |
|
VAERS ID: |
26603 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1990-10-24 |
Onset: | 1990-10-29 |
Days after vaccination: | 5 |
Submitted: |
1990-11-05 |
Days after onset: | 7 |
Entered: |
1990-11-09 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0A21149 / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0611B / 2 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-29
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: Proventil Syrup, Terbutaline Current Illness: BPD, Oxygen Dependency Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome. |
|
VAERS ID: |
26655 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1990-10-18 |
Onset: | 1990-10-25 |
Days after vaccination: | 7 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F112117 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Back pain SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Calan SR 240MG 1/2 tab daily. Current Illness: Preexisting Conditions: Hx of hypertension, cigarette smoking. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain. |
|
VAERS ID: |
26668 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Unknown |
Location: |
New York |
Vaccinated: | 1990-11-08 |
Onset: | 1990-11-11 |
Days after vaccination: | 3 |
Submitted: |
1990-11-13 |
Days after onset: | 2 |
Entered: |
1990-11-16 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0C21132 / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Bronchitis,
Laryngitis,
Otitis media,
Pharyngitis,
Pyrexia SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-11-11
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Mild cold Preexisting Conditions: normal child Allergies: Diagnostic Lab Data: CDC Split Type: CO3705
Write-up: Pt vaccinated with PROHIBIT mild cold at time of injection. Seen again 11NOV for subjective fever, worsening cold tugging at ears. Dx w/Otitis. Prescribed Augmentin, Codeine & Tylenol. Child found dead 6 hrs later in bed. Normal child |
|