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VAERS ID: 50879 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Illinois  
Vaccinated:1993-03-01
Onset:1993-03-02
   Days after vaccination:1
Submitted: 1993-03-11
   Days after onset:9
Entered: 1993-03-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 335929 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M020JE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338933 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: viral illness
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vaax 1MAR93; 2MAR92 recvd call that pt was in ER in asystole; found not breathing;


VAERS ID: 50966 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: West Virginia  
Vaccinated:1979-08-28
Onset:1979-08-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1993-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Asthma, Condition aggravated, Convulsion, Dysphagia, Muscle twitching, Pyrexia, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1979-09-04
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp sz @ 18 mos w/DTP #4;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: congenital heart defect?
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & devel wheezing, choked on milk, aspirated & went into some jerking movements; pt exp sz;


VAERS ID: 51067 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-03-15
Onset:1993-03-16
   Days after vaccination:1
Submitted: 1993-03-16
   Days after onset:0
Entered: 1993-03-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1116A2 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-16
   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
CDC Split Type:

Write-up: pt was unresponsive, pulsless, t31C, probable dx SIDS;


VAERS ID: 51155 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Nebraska  
Vaccinated:1993-03-11
Onset:1993-03-13
   Days after vaccination:2
Submitted: 1993-03-19
   Days after onset:6
Entered: 1993-03-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2C41012 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005JE / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0665M / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: NE935

Write-up: pt DOA @ hosp 13MAR93 7AM;


VAERS ID: 51251 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Mississippi  
Vaccinated:1993-01-14
Onset:1993-01-18
   Days after vaccination:4
Submitted: 1993-01-20
   Days after onset:2
Entered: 1993-03-29
   Days after submission:68
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41103 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338924 / 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: 1993-01-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS93011

Write-up: no adverse events noted @ time of vax; pt expired 18JAN93; COD SIDS; no autopsy rendered;


VAERS ID: 51271 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Virginia  
Vaccinated:1993-03-05
Onset:1993-03-05
   Days after vaccination:0
Submitted: 1993-03-23
   Days after onset:18
Entered: 1993-03-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1015V / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS, same day as Hep B vax recvd;


VAERS ID: 51417 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: New Jersey  
Vaccinated:1993-02-25
Onset:1993-02-28
   Days after vaccination:3
Submitted: 1993-03-19
   Days after onset:19
Entered: 1993-04-01
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2D41037 / 3 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120JJ / 3 - / IM L

Administered by: Private       Purchased by: Private
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-28
   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: complicated hx had AV canal w/single ventricle & pulmonary stenosis; had excessive pulmonary blood flow; surgery was complicated by chylothorax;
Allergies:
Diagnostic Lab Data: also had a tine test placed that day-no react per parents;
CDC Split Type:

Write-up: Pt was found dead in crib; was stable @ time of exam & parent report no apparent illness prior to death; no fever, no local rxn to vax noted by parents; MD felt poss arrhythmia


VAERS ID: 51419 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1993-03-16
Onset:1993-03-21
   Days after vaccination:5
Submitted: 1993-03-29
   Days after onset:8
Entered: 1993-04-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1517V / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS; no other info known on death or prior Hep B vax given;


VAERS ID: 51530 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1993-02-11
Onset:1993-02-25
   Days after vaccination:14
Submitted: 1993-03-22
   Days after onset:25
Entered: 1993-04-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 332985 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1016V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140JB / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 328962 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Pharyngitis, Sudden infant death syndrome
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK seen by MD-stuffy nose since birth;
Allergies:
Diagnostic Lab Data: ME?
CDC Split Type: FL93016

Write-up: SIDS death; pt had cold sx a/death; no treatment; mom stated mucus was coming out of nose & mouth when awoke & saw pt was dead; 16FEB92 had URI;


VAERS ID: 51535 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Hampshire  
Vaccinated:1992-11-05
Onset:0000-00-00
Submitted: 1993-03-16
Entered: 1993-04-02
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 2 GM / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605ID / 2 GM / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 661D6 / 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: 1992-11-20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS on 20NOV92;


VAERS ID: 51544 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Florida  
Vaccinated:1993-03-12
Onset:1993-03-12
   Days after vaccination:0
Submitted: 1993-03-31
   Days after onset:19
Entered: 1993-04-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985V / UNK - / SC

Administered by: Private       Purchased by: Other
Symptoms: Anorexia
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: premature infant
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93030817

Write-up: Pt recvd vax on 12MAR93 & exp loss of appetite & was presented back to MD office; MD felt child was fine; 13MAR92 the pt was found dead;


VAERS ID: 51548 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1993-03-22
Onset:1993-03-23
   Days after vaccination:1
Submitted: 1993-03-31
   Days after onset:8
Entered: 1993-04-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41073 / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120EJ / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 340923 / 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: 1993-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4729

Write-up: pt died 18 hrs p/vax;


VAERS ID: 51553 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: Iowa  
Vaccinated:1993-03-06
Onset:1993-03-08
   Days after vaccination:2
Submitted: 1993-03-08
   Days after onset:0
Entered: 1993-04-05
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 3 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1648V / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JA / 3 LL / -

Administered by: Public       Purchased by: Public
Symptoms: 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: 1993-03-08
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reports calling the death SIDS;
CDC Split Type: IA93006

Write-up: pt ran t103 was given APAP & died; pt had epicardial petehchiae, pleural petechiae; there was pulmonary congestion & edema, & congestion of the abdo viscera;


VAERS ID: 51576 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1993-03-12
Onset:1993-03-21
   Days after vaccination:9
Submitted: 1993-03-23
   Days after onset:2
Entered: 1993-04-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332973 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP, Decongestant, Antihistamine
Current Illness:
Preexisting Conditions: milk in tolerance; reflux
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9311

Write-up: pt died;


VAERS ID: 51579 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1993-01-25
Onset:1993-02-04
   Days after vaccination:10
Submitted: 1993-03-04
   Days after onset:28
Entered: 1993-04-05
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 322951 / 1 MO / PO

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

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: NONE
Current Illness: NONE
Preexisting Conditions: pt had newborn screen done on 25JAN93
Allergies:
Diagnostic Lab Data: autopsy being performed, mom does not yet have report;
CDC Split Type: TX93022

Write-up: SIDS;


VAERS ID: 51587 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Texas  
Vaccinated:1993-03-20
Onset:1993-03-20
   Days after vaccination:0
Submitted: 1993-03-22
   Days after onset:2
Entered: 1993-04-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41071 / 3 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1159V / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140JB / 3 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX93032

Write-up: unk @ this time;


VAERS ID: 51591 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Nevada  
Vaccinated:1993-03-26
Onset:1993-03-28
   Days after vaccination:2
Submitted: 1993-03-31
   Days after onset:3
Entered: 1993-04-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41071 / 1 LL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1160V / 1 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 674L2 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, 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: 1993-03-28
   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:
Current Illness: Contact dermatitis diaper area;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt died 2 days following administration of vax; Reporter stated "doubt that was related; Autopsy results pending;


VAERS ID: 51592 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1992-09-01
Onset:1992-09-04
   Days after vaccination:3
Submitted: 1993-03-22
   Days after onset:199
Entered: 1993-04-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 331913 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HJ / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Asthma, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), 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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: runny nose & occasional cough
Preexisting Conditions: colic
Allergies:
Diagnostic Lab Data: Autopsy findings were unremarkable, nl;
CDC Split Type:

Write-up: 1SEP92 10AM recvd vax-4-6PM non stop crying; 8PM started wheezing in bath, but quit; 3SEP92 7PM started wheezing during bath again; 4SEP92 approx 230PM quit breathing, heart stopped resuscitation unsuccesful;


VAERS ID: 51687 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1993-02-05
Onset:1993-02-21
   Days after vaccination:16
Submitted: 1993-03-16
   Days after onset:23
Entered: 1993-04-08
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 236 / 1 - / IM L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 237 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH 223 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 235 / 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: 1993-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Not known;
CDC Split Type:

Write-up: pt died of sids on 21FEB93


VAERS ID: 51688 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-03-29
Onset:1993-03-31
   Days after vaccination:2
Submitted: 1993-03-31
   Days after onset:0
Entered: 1993-04-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 116A2 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-31
   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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt brought in by fire/rescue to ER; pt was unresponsive, pulseless, found by mom w/blood around the nose; probable dx SIDS;


VAERS ID: 51699 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: New York  
Vaccinated:1993-02-12
Onset:1993-02-25
   Days after vaccination:13
Submitted: 1993-04-07
   Days after onset:40
Entered: 1993-04-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / -

Administered by: Private       Purchased by: Private
Symptoms: Hepatitis B surface antigen, Injury
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-04
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93030090

Write-up: Pt recvd vax on 15MAY92, 21AUG92 & 12FEB93 & on 28FEB92, lab eval revealed that pt had a pos HBsAg; repeat testing in a different lab, on 25FEB92 & 1MAR92 indicated neg HBsAg & pos anti-HBs; 4MAR93 pt died following head trauma;


VAERS ID: 51767 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Colorado  
Vaccinated:1993-01-05
Onset:1993-01-10
   Days after vaccination:5
Submitted: 1993-03-22
   Days after onset:71
Entered: 1993-04-12
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328933 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668M / 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: 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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CO93021

Write-up: pt recvd 5JAN93 & pt died of SIDS on 10JAN93; no reported sx post receiving vax;


VAERS ID: 51842 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1993-02-20
Onset:1993-02-20
   Days after vaccination:0
Submitted: 1993-04-07
   Days after onset:45
Entered: 1993-04-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (NO BRAND NAME) / PFIZER/WYETH 4928028 / UNK RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Dizziness, Nausea, Pain, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-02-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: cat scratch to rt arm;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt returned 1 hr & 35 mins p/vax c/o nausea & dizziness; daughter-in-law stated that pt had been c/o arm hurting and becoming numb & tingling, prior to returning to ER;


VAERS ID: 51900 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-04-01
Entered: 1993-04-19
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -

Administered by: Other       Purchased by: Other
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: No relevant data;
CDC Split Type: WAES93040018

Write-up: Pt recvd vax & died due to sudden infant death synd; pharmacist reported 2 pts; they were assigned WAES 93040017 & WAES 93040018; addt info has been requested;


VAERS ID: 51901 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-04-13
Entered: 1993-04-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -

Administered by: Other       Purchased by: Other
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: No relevant data;
CDC Split Type: WAES93040017

Write-up: pt recvd vax & died due to sudden infant death synd; pharmacist reported 2 pts; They were assigned WAES #93040017 & WAES 93040018; addtl info has been requested;


VAERS ID: 51976 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: South Carolina  
Vaccinated:1993-03-17
Onset:1993-03-31
   Days after vaccination:14
Submitted: 1993-04-07
   Days after onset:6
Entered: 1993-04-21
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 01554V / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: SC93048

Write-up: NONE noted or reported;


VAERS ID: 51982 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-04-02
Onset:1993-04-02
   Days after vaccination:0
Submitted: 1993-04-16
   Days after onset:13
Entered: 1993-04-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1112A2 / 1 LL / 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: 1993-04-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: SIDS death 3APR93; autopsy performed; submission of this report does not necessarily constitute an admission that the drug was responsible for the SIDS death;


VAERS ID: 51983 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-04-07
Onset:1993-04-08
   Days after vaccination:1
Submitted: 1993-04-16
   Days after onset:8
Entered: 1993-04-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 332999 / 3 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1112A2 / 3 RL / -

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: 1993-04-08
   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: Trisomy 21; IUGR
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recvd vax 7APR93 vax & died following day - was dx w/SIDS; autopsy performed;


VAERS ID: 51987 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Louisiana  
Vaccinated:1993-03-02
Onset:1993-03-03
   Days after vaccination:1
Submitted: 1993-04-16
   Days after onset:43
Entered: 1993-04-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328932 / 2 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1147V / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0670E / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Hepatic steatosis, Hypoxia, Petechiae, Pulmonary oedema, Right ventricular failure, Shock, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: recovering from chicken pox
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy report SIDS;
CDC Split Type: LA930410

Write-up: pt was found dead the day p/vax given 930AM 3MAR93;


VAERS ID: 52005 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Kansas  
Vaccinated:1993-04-05
Onset:1993-04-06
   Days after vaccination:1
Submitted: 1993-04-07
   Days after onset:1
Entered: 1993-04-23
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 331913 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125JD / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338924 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KS93013

Write-up: area where got vax was red & maybe bruised looking; moved leg OK; went to sleep 945 & woke up 3AM for a feeding; woke up 515AM, back to sleep 6AM; 745AM up & ate breakfast; 830AM pt put to bed; checked 1130-1145 hands were cold; CPR done;


VAERS ID: 52011 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Montana  
Vaccinated:1993-04-01
Onset:1993-04-05
   Days after vaccination:4
Submitted: 1993-04-07
   Days after onset:2
Entered: 1993-04-23
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2K31068 / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1433V / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1914T / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 330929 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cyanosis, Pyrexia, Skin discolouration, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unsure;
CDC Split Type: MT93016

Write-up: mom brough pt to ER "my baby is sick", pt unresponsive, mottled, blue; t109 R; resuscitation failed;


VAERS ID: 52135 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1993-03-02
Onset:1993-03-23
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 1993-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41073 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105JJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338925 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Haemorrhage, 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: 1993-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: SIDS; thymus gland petechial hemorrhages; cardiovascular system petechial hemorrhages resp system lungs mottled white & purple & w/petechial hemorrhages;


VAERS ID: 52142 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: Florida  
Vaccinated:1993-04-09
Onset:0000-00-00
Submitted: 1993-04-19
Entered: 1993-04-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 348981 / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M495JK / 1 RL / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 344939 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-10
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: Aldactone
Current Illness: NONE
Preexisting Conditions: premature 25 wks; failure to thrive; bronchopulmonary dysplasia, hypertonia-devel delay, dysphegia, hypothyroid, hear murmur, poor social dynamics, resp syncytial virus, adenovirus, rt middle lose pneumonia, hemophilus influenza meningitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dec @ home during noc discovered next morning;


VAERS ID: 52204 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Nevada  
Vaccinated:1993-04-14
Onset:1993-04-19
   Days after vaccination:5
Submitted: 1993-04-19
   Days after onset:0
Entered: 1993-04-28
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41071 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0674L / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Lung disorder, Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: post mortem scheduled for 20APR93;
CDC Split Type: NV93016

Write-up: pt recvd vax 14APR93 was given well baby exam @ time and found to be w/o problems; family states had no significant reaction to shots; appeared to be fine the day of demise;


VAERS ID: 52257 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Kansas  
Vaccinated:1993-04-06
Onset:1993-04-09
   Days after vaccination:3
Submitted: 1993-04-26
   Days after onset:17
Entered: 1993-04-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M495JK / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346930 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Conjunctivitis, Pallor, Sudden infant death syndrome
SMQs:, Severe cutaneous adverse reactions (broad), Acute central respiratory depression (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Polytrim ophth;
Current Illness: mild dacrostenosis rt eye
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy results confirm SIDS; No sign of infection, inflammation, injury etc;
CDC Split Type:

Write-up: pt recvd vax on 6APR93 had mild conjunctivitis rt eye dx''d good hlth; @ sitter AM 9APR found white, not breathing code blue unsuccessful; suspected SIDS but 72hrs w/in vax;


VAERS ID: 52302 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Georgia  
Vaccinated:1992-11-25
Onset:1992-12-07
   Days after vaccination:12
Submitted: 1993-03-29
   Days after onset:112
Entered: 1993-05-03
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328933 / 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: Public
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-12-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: wheezing secondary to woodstove heat
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA93064

Write-up: pt found in crib not breathing 6 or 7AM; death ruled SIDS-autopsy done;


VAERS ID: 52338 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1993-03-10
Onset:1993-03-16
   Days after vaccination:6
Submitted: 1993-04-19
   Days after onset:33
Entered: 1993-05-03
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 RL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0891T / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668M / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Lung disorder, Lymphadenopathy, Pericarditis, Petechiae, Pneumonia, Pulmonary haemorrhage, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO93030

Write-up: poss SIDS, bronchopneumonio, mild, respiratory, edema & endocarditis;


VAERS ID: 52379 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1993-04-02
Onset:1993-04-03
   Days after vaccination:1
Submitted: 1993-04-05
   Days after onset:1
Entered: 1993-05-04
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2C41012 / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0857V / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M605JD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0672A / 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: 1993-04-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed-report pending;
CDC Split Type: TN93037

Write-up: pt found dead @ home; suspected time of death 230AM-8AM on 3APR93; autopsy performed suspected SIDS death; according to funeral director mom states pt was fine when went to sleep;


VAERS ID: 52414 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1992-07-28
Onset:1992-08-13
   Days after vaccination:16
Submitted: 1992-09-01
   Days after onset:19
Entered: 1993-05-06
   Days after submission:247
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326983 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M225HL / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657K / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypothermia, Hypotonia, Mydriasis, Stupor, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-08-13
   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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS; cardiac arrest; pale, cool flaccid, cyanotic, unresponsive; no pulse; no respirations; side of head mottled & cyanotic in extremities; pupils fixed & dilated;


VAERS ID: 52579 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Unknown  
Vaccinated:1993-04-15
Onset:1993-04-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Infective pneumonia (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC Split Type:

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


VAERS ID: 52594 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:1993-02-04
Onset:1993-02-25
   Days after vaccination:21
Submitted: 1993-05-12
   Days after onset:75
Entered: 1993-05-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Aphasia, Coordination abnormal, Encephalitis, Neoplasm, Neuropathy, Nystagmus, Paraesthesia, Vertigo
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (narrow), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow), 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, ? days
   Extended hospital stay? No
Previous Vaccinations: pt exp double vision, dizziness @ 6 w/Engerix-B #1 dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: pt has hx of neurological disorders in the past;
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU930746

Write-up: pt recvd 2nd dose of vax 4FEB92 & 3 wks post inject exp double vision, dizziness & encephalitis; pt''s MD states devel vertigo, nystagmus, truncal ataxia, aphasia & numbness of the lt side of face; MRI''s done; demyelination of cerebellum;


VAERS ID: 52614 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Mississippi  
Vaccinated:1993-04-19
Onset:1993-05-01
   Days after vaccination:12
Submitted: 1993-05-07
   Days after onset:6
Entered: 1993-05-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2B41155 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338924 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Apnoea, Atelectasis, Brain oedema, Cardiac arrest, Hydrocephalus, Infection, Pneumonia
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), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy showed encephalotic organism;
CDC Split Type: MS93015

Write-up: mom states pt was not interested in feeding noc 30APR & early 1MAY morning; pt taken to ER was admitted for testing & observation; pt later arrested & was resusitated to ICU where arrested again & could not be revived;


VAERS ID: 52690 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1993-05-03
Onset:1993-05-04
   Days after vaccination:1
Submitted: 1993-05-04
   Days after onset:0
Entered: 1993-05-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41103 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105JJ / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0669C / 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: 1993-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE poss GE reflux;
Preexisting Conditions: frequent mild regurgitation, suspect gastroesoph reflux;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recvd vax 10AM & no intercurrent illness; h/o mild gastro-esophageal reflux-no medications; found dead in bed next morning, prone position;


VAERS ID: 52692 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1993-02-08
Onset:1993-02-09
   Days after vaccination:1
Submitted: 1993-05-13
   Days after onset:92
Entered: 1993-05-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Erythromycin Opth oint, Tri-vi-flor vitamin gtt;
Current Illness: NONE
Preexisting Conditions: conjunctivitis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: sudden death noc of 8FEB-9FEB <24 hrs p/vax;


VAERS ID: 52696 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1993-03-11
Onset:1993-03-14
   Days after vaccination:3
Submitted: 1993-05-11
   Days after onset:57
Entered: 1993-05-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41103 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 336928 / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Asthma, Haemorrhage, Hypoxia, Pulmonary oedema, Respiratory acidosis, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: dacrocystitis;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 52816 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Maryland  
Vaccinated:1993-05-14
Onset:1993-05-15
   Days after vaccination:1
Submitted: 1993-05-17
   Days after onset:2
Entered: 1993-05-19
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1119A2 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: ?SIDS autopsy pending;
CDC Split Type:

Write-up: death;


VAERS ID: 52918 (history)  
Form: Version 1.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1992-05-18
Entered: 1993-05-20
   Days after submission:367
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 5 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Gastrointestinal carcinoma
SMQs:, Lack of efficacy/effect (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Anti-HBs neg;
CDC Split Type: WAES92121428

Write-up: Pt recvd 3 doses of Hep B & booster dose & lab eval showed lack of seroconversion; dx w/carcinoma of the colon & it was felt that pt''s carcinoma was the reason had not responded to the series of vax;


VAERS ID: 53454 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:1993-02-06
Submitted: 0000-00-00
Entered: 1993-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3H41043 / UNK - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1077A2 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010JL / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 344945 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bronchitis, Lung disorder, Pharyngitis, Pulmonary oedema, Rhinitis, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Agranulocytosis (broad), Oropharyngeal infections (narrow), 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 53483 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:1993-02-26
Onset:1993-03-03
   Days after vaccination:5
Submitted: 1993-04-16
   Days after onset:43
Entered: 1993-06-01
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 1 RL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1521V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M020JE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 336930 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Dyspnoea, Infection, Leukocytosis, Pneumonia, Pulmonary oedema, Respiratory disorder, Sepsis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NaCl nasal gtts
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy findings of Haemophilus influenzae in blood culture;
CDC Split Type:

Write-up: Pt recvd vax & stopped breathing, had an odd color, had vomit in mouth; MD stated findings of haemophilus influenzae in the blood culture also poss sepsis; final dx hematopoietic sys haemophilus influenzae sepsis, pulm edema, aspiration;


VAERS ID: 53484 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Illinois  
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted: 1993-05-20
Entered: 1993-06-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-20
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: IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


VAERS ID: 53485 (history)  
Form: Version 1.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:1993-04-30
Onset:1993-05-02
   Days after vaccination:2
Submitted: 1993-05-25
   Days after onset:23
Entered: 1993-06-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1552V / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anxiety, Bronchitis, Cardiomegaly, Dyspnoea, Lung disorder, Myocarditis, Pericardial effusion, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-08
   Days after onset: 6
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: on 2MAY93 or 3MAY93 commented of not feeling well; went to ER on 6MAY93 w/cough & sore throat; given Bi-cillin & cough rxn w/Codeine; called in sick to work w/virus on 7MAY93; dec 8MAY93;


VAERS ID: 53486 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1993-05-11
Onset:1993-05-14
   Days after vaccination:3
Submitted: 1993-05-18
   Days after onset:4
Entered: 1993-06-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2F41092 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1116A2 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 342926 / 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: 1993-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt died of SIDS on 14MAY93;


VAERS ID: 53487 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Idaho  
Vaccinated:1993-05-27
Onset:1993-05-28
   Days after vaccination:1
Submitted: 1993-05-28
   Days after onset:0
Entered: 1993-06-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342972 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M490JK / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346997 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-28
   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: 1MAY93 sustained injury broken rt humerus;
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: pt had vax 2PM on 27MAY93 in office; did not have a physical just shots; mom did not note any problems in the afternoon; put pt to bed; 2AM 27MAY93 checked on pt; asystolic, apneic; t105;


VAERS ID: 53621 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: New York  
Vaccinated:1982-02-09
Onset:1982-02-23
   Days after vaccination:14
Submitted: 1993-06-04
   Days after onset:4118
Entered: 1993-06-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Brain oedema, Cardiac arrest, Dehydration, Diabetic coma, Faecaloma, Infection, Ketosis, Pancreatic disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1982-04-08
   Days after onset: 44
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: common cold; Roseola;
Allergies:
Diagnostic Lab Data: 8APR82 Autopsy-death determined to be diabetic ketoacidosis & coma; pancreas found to be virus infected;
CDC Split Type: WAES93050798

Write-up: pt recvd vax 9FEB82 & on 23FEB82 devel diabetic sx: excessive urination & thirst; parents did not recognize sx until pt went into coma 7APR92 following day pt died; pt was dehydrated w/early fecal impaction, pancreatic edema; cerebral edema


VAERS ID: 53638 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Carolina  
Vaccinated:1993-05-03
Onset:1993-05-18
   Days after vaccination:15
Submitted: 1993-05-20
   Days after onset:2
Entered: 1993-06-07
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1651V / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195JF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 332969 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Haemorrhage, Hyperglycaemia, Laryngeal oedema, Lung disorder, Subarachnoid haemorrhage, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt had Smith-McGuiness Syndrome, a form of growth & mental retardation; had hypoglycemia @ birth, hyperbilirubinemia, dysmorphic face, & undescended testicles;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: SC93075

Write-up: NONE


VAERS ID: 53642 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Oregon  
Vaccinated:1993-05-19
Onset:1993-05-22
   Days after vaccination:3
Submitted: 1993-06-02
   Days after onset:11
Entered: 1993-06-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2B41152 / 4 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 6T0K1 / 4 - / -

Administered by: Other       Purchased by: Public
Symptoms: Infection, Otitis media, Pyrexia, Respiratory disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-02
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Polyviflor, Carnitor, Zantal, Depakote, Pred,tums, Flexeril, Maalox;
Current Illness: NONE
Preexisting Conditions: cogental hydrocephalus w/shunt VP, sz disorder, Gastrostomy cerebral palssy devel delay
Allergies:
Diagnostic Lab Data: 24MAY93 G-site cult 3+ staph; 22MAY93 urine culture, no growth; 27MAY Amoxicillin started p/ MD recvd cult results;
CDC Split Type:

Write-up: pt recvd vax 19MAY93 & temp started 22MAY93 afebrile until then started vomiting; MD notified ear canal red, UA ordered, Maalox given, put on Pedialyte; 24MAY93 MD ordered cult 25MAY93; 27MAY93 throat cult returned amoxicillin started;


VAERS ID: 53644 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-05-20
Onset:1993-05-21
   Days after vaccination:1
Submitted: 1993-05-26
   Days after onset:5
Entered: 1993-06-07
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352957 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0677B / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Acidosis, Hypothermia, Peripheral vascular disorder, Personality disorder, Respiratory disorder, Shock, Stupor, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: sids
CDC Split Type:

Write-up: poss SIDS; doubt very much that vax caused death but death occurred w/in 1 1/2 days p/vax; didn''t feed well, wasn''t acting normally & had noisy breathing; diaper had diarrheal stool & looked pale & not responding nl; metabolic acidosis;


VAERS ID: 53687 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1993-05-14
Onset:1993-05-18
   Days after vaccination:4
Submitted: 1993-05-26
   Days after onset:8
Entered: 1993-06-08
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 344916 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M495JK / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0678F12 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: well child exam
Preexisting Conditions: no significant hx uneventful delivery-neg NB screen
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: verbal from ER MD pt arrived in ER in full cardio-pulmonary arrest; 18MAY93PM;


VAERS ID: 53808 (history)  
Form: Version 1.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-02-17
Onset:1993-03-11
   Days after vaccination:22
Submitted: 1993-03-25
   Days after onset:14
Entered: 1993-06-09
   Days after submission:75
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0669H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abortion, Coagulopathy, Infection, Influenza, Pyrexia, Renal failure, Sepsis, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Termination of pregnancy and risk of abortion (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-03-17
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergy: PCN; splenectomy 1972 due to trauma;
Allergies:
Diagnostic Lab Data: cultures & florescent antigens neg;
CDC Split Type: PA93013

Write-up: 11MAR93 w/fever, cough, flu-like sx; seen by MD collapsed & taken to hosp; presented typical septic process of meningococcal, pneumococcal or H. flu; was 5 wks pregnant spontaneously aborted; went into renal failure; COD DIC;


VAERS ID: 53887 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Indiana  
Vaccinated:1993-05-24
Onset:1993-06-02
   Days after vaccination:9
Submitted: 1993-06-03
   Days after onset:1
Entered: 1993-06-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342969 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M490JK / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 340923 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Amoxil
Current Illness: mild OM
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: full arrest pronounced DOA on arrival, then resuscitated; died 3JUN93 @ 940PM; dx SIDS;


VAERS ID: 53929 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Georgia  
Vaccinated:1993-01-15
Onset:1993-01-21
   Days after vaccination:6
Submitted: 1993-01-22
   Days after onset:1
Entered: 1993-06-14
   Days after submission:142
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1161V / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JB / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668D / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA93089

Write-up: 21JAN93 call recvd from med center stating that pt had died this morning-cause unk; also was informed that pt recvd vax on 9DEC922; 15JAN93 denied any hx of previous immun;


VAERS ID: 53961 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Mexico  
Vaccinated:1993-05-24
Onset:1993-05-25
   Days after vaccination:1
Submitted: 1993-05-26
   Days after onset:1
Entered: 1993-06-14
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352958 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 344943 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: CSF test abnormal, Convulsion, Haemorrhage intracranial, Meningitis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Septra
Current Illness:
Preexisting Conditions: recurrent OM, VSD on low dose Septra;
Allergies:
Diagnostic Lab Data: CSF WBC:1200; pro 598; RBC 710; CT scan subdural vs subarachnoid ICH;
CDC Split Type:

Write-up: aseptic meningitis w/intracranial hemorrhage, sz; onset w/in 24 hrs p/vax; pt was healthy a/vax given; FH pos sz;


VAERS ID: 54005 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:1993-01-25
Onset:1993-05-20
   Days after vaccination:115
Submitted: 1993-06-10
   Days after onset:21
Entered: 1993-06-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 5 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt non responder @ 74 w/Engerix-B #4;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6JAN93 titer neg; 7APr93 titer neg;
CDC Split Type: EBU930429

Write-up: Dialysis pt recvd 5 doses of Engerix-B & was found to be a nonresponder; 26APR93 pt self dicontinued the dialysis & died on 20MAy03;


VAERS ID: 54030 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1993-04-26
Onset:1993-04-26
   Days after vaccination:0
Submitted: 1993-05-25
   Days after onset:29
Entered: 1993-06-18
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 344916 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145JK / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 677H4 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Cardiovascular disorder, Congenital anomaly, Dyspnoea, Myocardial fibrosis, Necrosis, Petechiae, Stupor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amox, Nystatin oral;
Current Illness: ROM, thrush;
Preexisting Conditions: Supravalve aortic stenosis, heart murmur;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt w/known heart murmur, confirmed autopsy w/William''s synd w/stenosis; mild pulmonary stenosis; died suddenly that noc;


VAERS ID: 54068 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1993-05-28
Onset:0000-00-00
Submitted: 1993-06-04
Entered: 1993-06-21
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350915 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1552V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M90J5 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0679L / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: 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: 1993-05-30
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: Iron
Current Illness:
Preexisting Conditions: seen for well baby 30MAy no problem noted x/Hgb 95;
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX93084

Write-up: death;


VAERS ID: 54070 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted: 1993-01-28
Entered: 1993-06-21
   Days after submission:143
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
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 being investigated by ME:
CDC Split Type: WI93038

Write-up: pt was found dead in bed; no other sx were noted;


VAERS ID: 54190 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Unknown  
Vaccinated:1993-05-13
Onset:1993-05-15
   Days after vaccination:2
Submitted: 1993-06-11
   Days after onset:27
Entered: 1993-06-28
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pt recvd DTP vax IM #2 dose;
Current Illness: NONE
Preexisting Conditions: No family hx of SIDS
Allergies:
Diagnostic Lab Data: blood & urine screen on day of vax was unremarkable;
CDC Split Type: 930132701

Write-up: pt died 48 hrs p/2nd immun w/HBOC; COD given as SIDS; pt recvd vax @ 2, 4, & 6 mo not simultaneous w/HIB-TITER;


VAERS ID: 54233 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Missouri  
Vaccinated:1993-05-25
Onset:1993-06-01
   Days after vaccination:7
Submitted: 1993-06-10
   Days after onset:9
Entered: 1993-06-28
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 344917 / 3 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1123A2 / 3 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M01012 / 3 RL / -

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: 1993-06-01
   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: diaper rash
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO93041

Write-up: pt died poss SIDS autopsy results pending;


VAERS ID: 54245 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1993-05-13
Onset:1993-05-20
   Days after vaccination:7
Submitted: 1993-06-11
   Days after onset:22
Entered: 1993-06-28
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 349907 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338931 / 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: 1993-05-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: OK9326

Write-up: dx as SIDS;


VAERS ID: 54273 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Nevada  
Vaccinated:1993-06-10
Onset:1993-06-13
   Days after vaccination:3
Submitted: 1993-06-18
   Days after onset:5
Entered: 1993-06-29
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 349907 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1160V / 1 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M1955F / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 674L / 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: 1993-06-13
   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: Torica only Nystatin 10JUN93;
Current Illness: oral thrush
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy-no cause found: dx SIDS;
CDC Split Type:

Write-up: pt died in sleep 60 hrs p/vax; autopsy dx SIDS;


VAERS ID: 54458 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1992-12-14
Onset:1993-02-02
   Days after vaccination:50
Submitted: 1993-06-28
   Days after onset:145
Entered: 1993-07-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2K31068 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005TE / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: not obtained-autopsy obtained;
CDC Split Type:

Write-up: SIDS event 2FEB93;


VAERS ID: 54459 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Louisiana  
Vaccinated:1993-06-22
Onset:1993-06-24
   Days after vaccination:2
Submitted: 1993-06-28
   Days after onset:4
Entered: 1993-07-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352922 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 340923 / 1 MO / PO

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: 1993-06-26
   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: Levsin, Rocephin;
Current Illness: NONE
Preexisting Conditions: opitz trigonencephaly synd; multiple congen abnormalities;
Allergies:
Diagnostic Lab Data: Nl urine & chest xray;
CDC Split Type:

Write-up: fever 102 ax 48 hrs p/immun; pt devel fever of 102 at 48 hrs p/vax, died 2 days p/fever started; MDs think death was attribut to Opitz syndrome;


VAERS ID: 54505 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:1993-04-15
Onset:1993-05-31
   Days after vaccination:46
Submitted: 1993-06-28
   Days after onset:28
Entered: 1993-07-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1255V / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Cough, Cyanosis, Pyrexia, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-11
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk;
CDC Split Type: IL93058

Write-up: Taken to ER 31MAY93 for resp problems; i.e., coughing until lost breath; saw MD 9JUN93 & given ATB & bronchodil; seen by nurse on 10JUN93; child had paroxysmal cough followed by cyanosis; inst to call MD as pt also febrile; ATB was Keflex..


VAERS ID: 54554 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Alabama  
Vaccinated:1993-04-14
Onset:1993-05-06
   Days after vaccination:22
Submitted: 1993-07-02
   Days after onset:57
Entered: 1993-07-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 3 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1117A2 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145JK / 3 LL / IM

Administered by: Public       Purchased by: Public
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: 1993-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Fer-in sol gtts;
Current Illness: NONE
Preexisting Conditions: hemoglobin 11.3; MCV 73;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS confirmed by autopsy;


VAERS ID: 54555 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Colorado  
Vaccinated:1993-06-28
Onset:1993-07-02
   Days after vaccination:4
Submitted: 1993-07-02
   Days after onset:0
Entered: 1993-07-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41071 / 1 - / L
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1015V / 2 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145JK / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 2O41892 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: newborn screen, f/u PKU nl;
CDC Split Type:

Write-up: nl state of hlth until 10AM 2JUL93; put down for nap; mom found baby stiff & unresponsive; mom performed CPR on way into ER: per ER MD, no rhythm ever obtained; pronounded dead; SIDS;


VAERS ID: 54621 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1993-06-21
Onset:1993-06-22
   Days after vaccination:1
Submitted: 1993-06-25
   Days after onset:3
Entered: 1993-07-12
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 330911 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M020JE / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 340920 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Haemorrhage, Injection site haemorrhage, Injection site inflammation, Lung disorder, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Nystatin suspension for oral thrush;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy was done 24JUN93 which was entirely nl, particular attention paid to eval immun sites, no abn findings noted;
CDC Split Type: WA93925

Write-up: Pt recvd vax as part of routine 4 mos well baby visit; pt cried that evening but appeared fine, happy & nl next AM; parents found pt dead in crib that afternoon-SIDS death;


VAERS ID: 54656 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1993-06-24
Onset:1993-06-25
   Days after vaccination:1
Submitted: 1993-07-06
   Days after onset:11
Entered: 1993-07-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120JJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0672C / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-25
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: initial autopsy-final autopsy results pending;
CDC Split Type: NH93007

Write-up: pt recvd vax on 24JUN93 in AM; found unresponsive in crib by parent on 25JUN93 around 5AM; emergency medical providers & hosp unable to resucitate; COD SIDS;


VAERS ID: 54764 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: Unknown  
Vaccinated:1993-03-25
Onset:1993-03-25
   Days after vaccination:0
Submitted: 1993-07-12
   Days after onset:108
Entered: 1993-07-21
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 334981 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1391V / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: dx of upper resp infect, OM 10FEB93;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt''s history & autopsy findings consistent w/SIDS; had recvd routine vax OPV/DTP/HIB earlier on same day;


VAERS ID: 54770 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Arizona  
Vaccinated:1993-07-07
Onset:1993-07-14
   Days after vaccination:7
Submitted: 1993-07-16
   Days after onset:2
Entered: 1993-07-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1063B2 / 3 - / IM L
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: CSF test abnormal, Infection, Lung disorder, Pulmonary haemorrhage, Pulmonary oedema, Sepsis, Stupor, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-07-14
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: upper respiratory infection;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 930002021

Write-up: pt recvd vax & 7 days p/vax pt exp sudden infant death synd; reporting MD indicated that pt also recvd DTP/HIB @ the same time as the 3rd dose of Engerix-B:


VAERS ID: 54843 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:1993-06-07
Onset:1993-06-10
   Days after vaccination:3
Submitted: 1993-06-10
   Days after onset:0
Entered: 1993-07-26
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0674K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiomegaly, Cardiovascular disorder, Congenital anomaly, Cyanosis, Hepatic steatosis, Myocardial fibrosis, Petechiae
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx asplenia; single ventircle; single AUL; pulmonary valve atresia; patent ductus arteriosus; (heart defect);
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: TX93094

Write-up: 10JUN93 ambulance was called pt dead @ scene;


VAERS ID: 54915 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1993-04-20
Onset:1993-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1993-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH - / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
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: 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: autopsy dx SIDS (preliminary);
CDC Split Type:

Write-up: nl delivery, return for 2 month well baby check up, recvd vax listed below (pt appeared to be healthy); 1 day p/vax arrived in ER DOA w/high core temp;


VAERS ID: 54940 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1993-06-16
Onset:0000-00-00
Submitted: 1993-06-29
Entered: 1993-07-30
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195JF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0679H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-18
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy sudden infant death synd;
CDC Split Type: OH93052

Write-up: 18JUN93 pt expired; had no noticable adverse reaction from vax;


VAERS ID: 55227 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Hampshire  
Vaccinated:1993-06-18
Onset:1993-07-04
   Days after vaccination:16
Submitted: 1993-08-03
   Days after onset:30
Entered: 1993-08-16
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 349902 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M490 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 342964 / 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: 1993-07-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH93010

Write-up: SIDS death 4JUL93;


VAERS ID: 55252 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1993-04-21
Onset:1993-04-29
   Days after vaccination:8
Submitted: 1993-06-15
   Days after onset:47
Entered: 1993-08-16
   Days after submission:62
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1433V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035JH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0670M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: stuffy nose
Preexisting Conditions: bronchiolitis FEB93; term LGA infant;
Allergies:
Diagnostic Lab Data: no written report recvd by clinic;
CDC Split Type: TN93068

Write-up: RN was notified by coroner''s office that pt died of SIDS 29APR93;


VAERS ID: 55293 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Ohio  
Vaccinated:1993-07-21
Onset:0000-00-00
Submitted: 1993-08-16
Entered: 1993-08-18
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41062 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010JL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0683H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Lung disorder, 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: 1993-07-31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling died of SIDS p/receiving DTP/OPV #1;~ ()~~~In Sibling
Other Medications:
Current Illness: NA
Preexisting Conditions: apnea monitor @ noc only-prophylaxis;
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH93063

Write-up: SIDS;


VAERS ID: 55354 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: South Dakota  
Vaccinated:1993-01-19
Onset:1993-01-22
   Days after vaccination:3
Submitted: 1993-08-08
   Days after onset:197
Entered: 1993-08-19
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2C41012 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195JF / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0673A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Crying, Diarrhoea, Myalgia, Personality disorder, Rhinitis, Somnolence, Sudden infant death syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-01-26
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp slight fever/runny nose;~ ()~~~In patient
Other Medications: APAP for soreness/stiffness;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PKU-nl; CBC @ birth = 18,500 white count/hemoglobin 20 gr;
CDC Split Type: SD93023

Write-up: pt recvd vax 19JAN93 & 4PM & 22JAN had runny nose; 23JAN didn''t eat well; 24JAN acting rather strangely; while in church passed alot of gas & screaming; loose & strange looking stools; restless; Would nap a short bit; up @ noc; SIDS;


VAERS ID: 55368 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1993-06-24
Onset:1993-07-17
   Days after vaccination:23
Submitted: 1993-07-29
   Days after onset:12
Entered: 1993-08-19
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41062 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1116A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M645JK / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0682D / 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: 1993-07-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flouride
Current Illness: NONE
Preexisting Conditions: premature 5-6wks;
Allergies:
Diagnostic Lab Data: autopsy-confirmed SIDS;
CDC Split Type:

Write-up: SIDS on 17JUL93 autopsy done;


VAERS ID: 55369 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-08-12
Onset:1993-08-12
   Days after vaccination:0
Submitted: 1993-08-16
   Days after onset:4
Entered: 1993-08-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2D41037 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M170KB / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Delirium, Dysphagia, Mydriasis, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-08-13
   Days after onset: 1
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? Yes
Previous Vaccinations: pt exp small local knot @ inject site @ 4mos w/DTP #2;~ ()~~~In patient
Other Medications: possibly APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Toxic screen @ hsop (?results); CXR-no gorss evidence of aspiration; autopsy results pending;
CDC Split Type:

Write-up: pt recvd vax 12AUG93 & @ 1230PM pt vomited, choked, turned blue during feeding; 911 called pt reported w/o HR or resp effort when ENT arrived; taken to ER; pupils fixed, dialated; irreversible brain damage-vent support d/cd 13AUG93;


VAERS ID: 55460 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Maryland  
Vaccinated:1981-09-22
Onset:1981-09-22
   Days after vaccination:0
Submitted: 1993-08-20
   Days after onset:4350
Entered: 1993-08-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Lung disorder, Pulmonary oedema, Pyrexia, Somnolence, Stupor, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1981-09-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp rxn @ 2mos w/DTP all doses;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy SIDS;
CDC Split Type:

Write-up: shot administered on 22SEP81 intermittent fever all that day; 23SEP prolonged sleeping/unresponsive; found dead on morning 24SEP81;


VAERS ID: 55461 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Illinois  
Vaccinated:1993-08-09
Onset:1993-08-14
   Days after vaccination:5
Submitted: 1993-08-18
   Days after onset:4
Entered: 1993-08-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41111 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346937 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-15
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature infant 34 wks;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: history from mom-well baby exam approx 9AUG93 given immun DTP/HIB/OPV 14AUG runny nose;


VAERS ID: 55462 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Missouri  
Vaccinated:1993-01-04
Onset:1993-01-05
   Days after vaccination:1
Submitted: 1993-08-11
   Days after onset:217
Entered: 1993-08-24
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2K31068 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1066A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005JE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 330983 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Crying, Haemorrhage, Lung disorder, Pain, Screaming, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-17
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: immun given 4JAN93-no adverse reactions noted; pt brought to ER 17FEB93 DOA pt started on 5JAN93 terrible crying like alot of pain; cont awful crying everyday till passed away;


VAERS ID: 55729 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1993-04-21
Onset:1993-04-21
   Days after vaccination:0
Submitted: 1993-04-28
   Days after onset:7
Entered: 1993-09-02
   Days after submission:127
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1015V / 1 LA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M490JK / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0672K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Gaze palsy, 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), Ocular motility disorders (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-22
   Days after onset: 1
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: autopsy done-SIDS;
CDC Split Type: CO93054

Write-up: 22APR93 pt died; pt had been fussy & some fever until 2AM, @ 1 point eyes rolled back in head; then both pt & parents to sleep; 7AM check pt dead; family & godmom concerned pt had recvd immun 21APR; 23APR tc to SIDS center pt died of SIDS;


VAERS ID: 55731 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Colorado  
Vaccinated:1993-04-15
Onset:1993-04-16
   Days after vaccination:1
Submitted: 1993-05-04
   Days after onset:18
Entered: 1993-09-02
   Days after submission:121
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M1953F / 3 RL / -

Administered by: Other       Purchased by: Public
Symptoms: Haemorrhage, Hepatic steatosis, Rhinitis, Sudden infant death syndrome
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-17
   Days after onset: 1
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: rt cleft lip completely intact palate-repaired 24FEB93;
Allergies:
Diagnostic Lab Data: autopsy consistent w/SIDS;
CDC Split Type: CO93056

Write-up: mom states that pt had runny nose when put to bed 16APR93;


VAERS ID: 55776 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Alaska  
Vaccinated:1993-07-19
Onset:0000-00-00
Submitted: 1993-08-17
Entered: 1993-09-07
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1642V / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 336999 / 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: 1993-08-17
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: AK93014

Write-up: 2SEP93 parents stated pt was dx''d as having died of SIDS; this was 17 days following vax (w/no known adverse reaction);


VAERS ID: 55900 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Georgia  
Vaccinated:1993-05-12
Onset:0000-00-00
Submitted: 1993-05-27
Entered: 1993-09-09
   Days after submission:105
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 349907 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M75HJ / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0678E / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: MAR93 ear infect, wheezing;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA93119

Write-up: no adverse reaction to vax was reported to clinic; pt death was seen in newspaper; copy of autopsy & death certificate to follow;


VAERS ID: 55921 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Georgia  
Vaccinated:1993-04-15
Onset:1993-04-17
   Days after vaccination:2
Submitted: 1993-07-06
   Days after onset:80
Entered: 1993-09-09
   Days after submission:65
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41072 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1161V / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06680 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, 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: 1993-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt treated for pneumonia about 4 mos prior to death & seen in ER for chest congestion about 2 mos prior to death;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: GA93141

Write-up: death-natural;


VAERS ID: 55922 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Georgia  
Vaccinated:1993-06-10
Onset:1993-07-07
   Days after vaccination:27
Submitted: 1993-07-08
   Days after onset:1
Entered: 1993-09-09
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 349904 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M57HL / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Acidosis, Coagulopathy, Leukopenia, Meningitis, Purpura, Sepsis, Shock, Thrombocytopenia
SMQs:, Anaphylactic reaction (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93142

Write-up: 8JUL93 MD reported to nurse that pt became ill was taken to hosp & died dx w/Nisseria meningitides menigitis; dx: gram negative shock due to meningococcemia;


VAERS ID: 55936 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: West Virginia  
Vaccinated:1993-09-02
Onset:1993-09-03
   Days after vaccination:1
Submitted: 1993-09-03
   Days after onset:0
Entered: 1993-09-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1202B2 / 1 RL / IM

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

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

Write-up: according ot father who called pt had no fever, was acting well & feeding well; pt was found in crib w/no signs of life @ about 2AM & taken to the local ER where was pronounced DOA;


VAERS ID: 56051 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Maryland  
Vaccinated:1993-08-16
Onset:0000-00-00
Submitted: 1993-09-07
Entered: 1993-09-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1098A4 / 2 LL / -

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

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

Write-up: hep B vax 16AUG93 & pt expired the following day;


VAERS ID: 56072 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1993-08-12
Onset:1993-08-14
   Days after vaccination:2
Submitted: 1993-09-09
   Days after onset:26
Entered: 1993-09-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352957 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0685L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: extra digits both hands
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recvd vax 12AUG93; on morning of 14AUG93 pt was taken to hosp DOA; autopsy stated no gross abnormality; baby was reported healthy without problems following vaxs;


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