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VAERS ID: 56174 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maryland  
Vaccinated:1993-09-07
Onset:1993-09-08
   Days after vaccination:1
Submitted: 1993-09-14
   Days after onset:6
Entered: 1993-09-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352922 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 354960 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-08
   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: Poly vi sol, Ferinsol;
Current Illness: poor growth
Preexisting Conditions: 29 wk premature;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: death-pt brought in DOA to ER 1 day p/vax;


VAERS ID: 56175 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Texas  
Vaccinated:1993-07-23
Onset:1993-08-10
   Days after vaccination:18
Submitted: 1993-09-14
   Days after onset:35
Entered: 1993-09-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC Split Type:

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


VAERS ID: 57496 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Texas  
Vaccinated:1992-10-10
Onset:1992-10-23
   Days after vaccination:13
Submitted: 1993-09-14
   Days after onset:326
Entered: 1993-09-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


VAERS ID: 56194 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:1993-09-07
Onset:1993-09-07
   Days after vaccination:0
Submitted: 1993-09-17
   Days after onset:10
Entered: 1993-09-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0636W / 1 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Hypotonia
SMQs:, Peripheral neuropathy (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-08
   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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unavailable @ this time;
CDC Split Type:

Write-up: pt stopped breathing & went limp; was shook by father & taken to ER: CPR done; put on respirator; declared brain dead 1-2 days later & machine turned off; not sure what if any relationship exist between vax & following events;


VAERS ID: 56203 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maryland  
Vaccinated:1993-06-17
Onset:1993-06-21
   Days after vaccination:4
Submitted: 1993-09-16
   Days after onset:87
Entered: 1993-09-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350917 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1060A4 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M555JK / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346936 / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Diarrhoea, Hydrocephalus, Pneumonia, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-21
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed-results are not available
CDC Split Type: MD93028

Write-up: devel vomiting & watery stool 3 day 20JUN p/vax; seen by MD was hydrated; next AM pt found unresponsive in bed; taken to ER but did not respond;


VAERS ID: 56257 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Minnesota  
Vaccinated:1993-08-01
Onset:1993-08-01
   Days after vaccination:0
Submitted: 1993-08-30
   Days after onset:29
Entered: 1993-09-27
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 353904 / UNK LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1197B2 / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 352948 / UNK 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: 1993-08-07
   Days after onset: 6
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: 930186501

Write-up: pt recvd vax & approx 1 wk later pt died; COD SIDS; no details available from reporter; family hx of SIDS;


VAERS ID: 56292 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-07-19
Onset:0000-00-00
Submitted: 1993-08-06
Entered: 1993-09-27
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0451W / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-07-22
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:
CDC Split Type: PA93102

Write-up: 17JUL93 pt was administered HEP B ax & 222JUL93 had massive coronary;


VAERS ID: 56444 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: West Virginia  
Vaccinated:1993-09-27
Onset:0000-00-00
Submitted: 1993-09-29
Entered: 1993-10-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 349907 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010JN / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0687B / 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: 1993-09-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found dead in crib of 2AM;


VAERS ID: 56467 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-02
   Days after onset:1
Entered: 1993-10-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938137 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 340938 / 1 RA / -

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: 1993-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Sinemet; Parlodel, Xanax, Doxepin, Furosemide, ASA, Paxil
Current Illness: parkinsons, skin (contact derm);
Preexisting Conditions: sulfa/motrin advanced parkinsons disease;
Allergies:
Diagnostic Lab Data: last labs 20AUG93 Serum NA 127; serum CA+ 8.5; chlorids 88;
CDC Split Type:

Write-up: resp/cardiac arrest;


VAERS ID: 56483 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1993-09-01
Onset:1993-09-21
   Days after vaccination:20
Submitted: 1993-09-27
   Days after onset:6
Entered: 1993-10-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41111 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1651V / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180KB / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356941 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-21
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL93106

Write-up: @ approx 6AM on 21SEP93 mom awoke found pt had expired; pt taken to ER:


VAERS ID: 56496 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:1993-06-10
Onset:1993-06-11
   Days after vaccination:1
Submitted: 1993-10-07
   Days after onset:118
Entered: 1993-10-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1427V / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Anxiety, Dizziness, Intentional overdose, Lymphadenopathy, Nausea, Paraesthesia, Suicide attempt
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Suicide/self-injury (narrow), Anticholinergic syndrome (broad), Drug abuse and dependence (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-13
   Days after onset: 94
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: mental illness
Preexisting Conditions: mental illness
Allergies:
Diagnostic Lab Data: pt died from self inflicted gunshot wound;
CDC Split Type: WAES93061208

Write-up: pt recvd vax 10JUN93 & 11JUN93 pt exp numbness, tingling, swollen lymph nodes, lightheadedness w/dizziness, nausea & some rather weird & vague reaction; MD felt these reactions could have been due to anxiety react; pt ingested 100 pills;


VAERS ID: 56537 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1993-02-12
Onset:1993-03-05
   Days after vaccination:21
Submitted: 1993-04-05
   Days after onset:30
Entered: 1993-10-12
   Days after submission:190
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2M31091 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657L / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Condition aggravated
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pulmonary stenosis
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA93182

Write-up: pulmonary valvular stenosis;


VAERS ID: 56555 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oklahoma  
Vaccinated:1993-09-30
Onset:1993-09-30
   Days after vaccination:0
Submitted: 1993-10-04
   Days after onset:4
Entered: 1993-10-12
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41062 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH W1490JK / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0683F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk;
CDC Split Type: OK9351

Write-up: redness & swelling of thigh, t101, crying 3 1/2 hrs; onset approx-noon; MD office approx 2-3PM;


VAERS ID: 56603 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-09-30
   Days after vaccination:0
Submitted: 1993-10-01
   Days after onset:1
Entered: 1993-10-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


VAERS ID: 56638 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:1993-08-20
Onset:1993-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Brain oedema, Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC Split Type:

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


VAERS ID: 56721 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:1993-10-09
Onset:1993-10-10
   Days after vaccination:1
Submitted: 1993-10-12
   Days after onset:2
Entered: 1993-10-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Deep vein thrombosis, Nausea, Pulmonary embolism, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: 1993-10-10
   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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


VAERS ID: 56731 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Colorado  
Vaccinated:1993-06-08
Onset:1993-06-19
   Days after vaccination:11
Submitted: 1993-07-08
   Days after onset:19
Entered: 1993-10-25
   Days after submission:109
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1147V / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195JF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0677F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Cyanosis, Neoplasm, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tempra;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: final autopsy report myocardial hamartomas;
CDC Split Type: CO93065

Write-up: sl temp evening of 8JUN93 tempra given; pt woke up once during noc of 9JUN93 fussy & given tempra; 19JUN93 pt woke up crying in AM; cry as if in pain; pt stopped breathing & turned blue; called 911 started CPR;


VAERS ID: 56821 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1993-10-04
Onset:1993-10-05
   Days after vaccination:1
Submitted: 1993-10-08
   Days after onset:3
Entered: 1993-10-28
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350919 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0937W / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0680H / 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: 1993-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: healthy;
Preexisting Conditions: pt had sl head cold 2 wks prior; had resolved;
Allergies:
Diagnostic Lab Data: ME reports no gross abnormalities or signs of abuse; full autopsy results pending;
CDC Split Type: 930212701

Write-up: pt recvd vax 4OCT93; no sx; given Tempra shortly p/vax; pt went to sleep 650PM; woke @ 1050PM; appeared fine; put back to sleep; 8AM 5OCT93 pt found dead in crib;


VAERS ID: 56832 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:1993-10-01
Onset:1993-10-11
   Days after vaccination:10
Submitted: 1993-10-20
   Days after onset:9
Entered: 1993-10-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-14
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide-Micro K; Ventolin-Aero Bid uniphyl;
Current Illness: NONE
Preexisting Conditions: bronchial asthma, hypertensive cardio vascular disease;
Allergies:
Diagnostic Lab Data: LP-nl; EMG-nl; consistant w/GBS:
CDC Split Type:

Write-up: ascending paralysis, w/resp failure, consistant w/GBS;


VAERS ID: 56851 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-10-28
Onset:1993-10-29
   Days after vaccination:1
Submitted: 1993-10-29
   Days after onset:0
Entered: 1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), 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), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


VAERS ID: 56914 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Florida  
Vaccinated:1993-10-22
Onset:1993-10-25
   Days after vaccination:3
Submitted: 1993-10-26
   Days after onset:1
Entered: 1993-11-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342970 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035JH / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0689L / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: atopic dermatitis
Allergies:
Diagnostic Lab Data: ME report pending;
CDC Split Type:

Write-up: pt found dead in bed;


VAERS ID: 56919 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-09-29
Onset:1993-09-30
   Days after vaccination:1
Submitted: 1993-10-27
   Days after onset:27
Entered: 1993-11-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-01
   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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


VAERS ID: 56972 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Texas  
Vaccinated:1993-09-30
Onset:0000-00-00
Submitted: 1993-10-04
Entered: 1993-11-02
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3L41093 / 2 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0845W / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0684A / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-02
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: heart murmur @ birth; lt undescended testicle;NKDA;
Allergies:
Diagnostic Lab Data: unk-ME report pending;
CDC Split Type: TX93173

Write-up: unk ME report is pending;


VAERS ID: 57001 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1993-10-25
Onset:1993-10-26
   Days after vaccination:1
Submitted: 1993-11-01
   Days after onset:6
Entered: 1993-11-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1268B2 / 2 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 688EG / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: prematurity apnea of prematurity-resolved;
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: sudden death;


VAERS ID: 57008 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-18
   Days after onset:17
Entered: 1993-11-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Hyperventilation, Hypocalcaemia, Leukocytosis, Pneumonia, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Prednisone; Methotrexate;
Current Illness:
Preexisting Conditions: pulmonary fibrosis, past hx TB, theumatoid arthritis;
Allergies:
Diagnostic Lab Data: family refused autopsy;
CDC Split Type: CO5040

Write-up: died p/being hospitalized for interstitial pneumonia; day p/vax felt SOB & started to cough; 5OCt admitted;


VAERS ID: 57231 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arizona  
Vaccinated:1993-10-28
Onset:1993-10-30
   Days after vaccination:2
Submitted: 1993-11-01
   Days after onset:2
Entered: 1993-11-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0917W / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 355951 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Encephalopathy, Hypoxia, Oedema, Petechiae
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (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), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiorespirratory arrest while sleeping 30OCT93 @ 1600;


VAERS ID: 57317 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Ohio  
Vaccinated:1993-10-20
Onset:0000-00-00
Submitted: 1993-10-29
Entered: 1993-11-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41062 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M01JL / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Myocarditis, Pneumonia, Spleen disorder
SMQs:, Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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: 1993-10-25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH93086

Write-up: unk


VAERS ID: 57323 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-09-13
Onset:1993-09-14
   Days after vaccination:1
Submitted: 1993-10-29
   Days after onset:45
Entered: 1993-11-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 493814 / UNK - / A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Blood thromboplastin decreased, Confusional state, Dementia, Encephalitis, Leukopenia, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: remains hospitalized on ventilator; outcome remains guarded;
Allergies:
Diagnostic Lab Data: WBC 2.3; nl 4-11; sed rate 36; Ptt 5; CSF WNL; Bl no grwoth; titer for EEE, california E, st louis E pending; Enterovirus & Herpes cultures being done on CSF;;
CDC Split Type:

Write-up: rapid progressive dementia ventilation for respiratory failure, t105; family states confusion started about 16 hrs p/vax; post flu vax encephalitis;


VAERS ID: 57393 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1993-09-09
Onset:1993-09-24
   Days after vaccination:15
Submitted: 1993-11-04
   Days after onset:41
Entered: 1993-11-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0455W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0682K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy-gross exam dx SIDS;
CDC Split Type: NH93020

Write-up: SIDS;


VAERS ID: 57448 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Missouri  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-11-12
Entered: 1993-11-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hepatitis B surface antigen, 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: 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: WAES93101505

Write-up: pt recvd vax & 3 months later pt died; @ the autopsy Hep B surface antigen was detected in the blood;


VAERS ID: 57456 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:1977-04-24
Onset:1977-04-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-01
   Days after onset: 4574
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tri Solgen
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: US93102170A

Write-up: Pt recvd vax 24APR77 & suffered severe brain damage & cont sz until death on 1NOV89; summons allerges death was a direct result of complications caused by react to vax;


VAERS ID: 57467 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Jersey  
Vaccinated:1993-10-19
Onset:1993-10-20
   Days after vaccination:1
Submitted: 1993-11-12
   Days after onset:23
Entered: 1993-11-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2B41152 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1516V / 1 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M040JH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0673A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy report;
CDC Split Type: NJ9326

Write-up: pt fussy p/shots; t100 mom called clinic; slept well during noc; 1520 found unresponsive & not breathing; mom started CPR until ambulance arrived; brought to hosp; 1555 in full cardiac arrest;


VAERS ID: 57470 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-10-01
Onset:1993-10-17
   Days after vaccination:16
Submitted: 1993-11-10
   Days after onset:24
Entered: 1993-11-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC Split Type:

Write-up: poss transverse myelitis w/paralysis from chest down;


VAERS ID: 57481 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Wisconsin  
Vaccinated:1993-11-01
Onset:1993-11-01
   Days after vaccination:0
Submitted: 1993-11-16
   Days after onset:15
Entered: 1993-11-18
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NO relevant data;
CDC Split Type: WAES93110254

Write-up: Pt recvd vax 1NOV93 & 2NOV93 the pt devel congestive heart failure & was hospitalized;


VAERS ID: 57492 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1993-10-20
Onset:1993-10-31
   Days after vaccination:11
Submitted: 1993-11-08
   Days after onset:8
Entered: 1993-11-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350916 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1161V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305JH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: heart murmur-1st born of twins;
Allergies:
Diagnostic Lab Data: spoke w/parent on 3NOV93 & stated had no problems w/vax;
CDC Split Type: TN93107

Write-up: SIDS no autopsy done;


VAERS ID: 57550 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:1977-04-24
Onset:0000-00-00
Submitted: 1993-11-03
Entered: 1993-11-22
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Convulsion, Delirium
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893307021J

Write-up: Pt recvd vax 24APR77 & pt devel convuls & was hospitalized; suffered severe brain damage & cont to have sz until death on 1NOV89;


VAERS ID: 57571 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted: 1993-09-28
Entered: 1993-11-22
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), 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), 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: 1993-08-14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


VAERS ID: 57599 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:1993-10-06
Onset:1993-10-12
   Days after vaccination:6
Submitted: 1993-10-13
   Days after onset:1
Entered: 1993-11-22
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Atrial septal defect, Brain oedema, Hepatocellular damage, Infection, Neuropathy, Pulmonary oedema, Somnolence
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pediacare
Current Illness: nasal congestion
Preexisting Conditions: questionable failure to thrive dec gray matter & mylinization;
Allergies:
Diagnostic Lab Data: preliminary autopsy results cerebral edema & lung congested;
CDC Split Type: NYS93072

Write-up: pt seen by ER on 11OCT93 for inc lethargy & sl temp 101; dec & appetite;


VAERS ID: 57604 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1993-10-28
Onset:1993-10-31
   Days after vaccination:3
Submitted: 1993-11-01
   Days after onset:1
Entered: 1993-11-22
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3051025 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1159V / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M040JH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 348936 / 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: 1993-10-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: SPectazole-topical cream for idaper rash;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy to be performed @ hosp;
CDC Split Type: NYS93077

Write-up: poss SIDS brought to hosp 12nppn 31OCT93; DOA no prev s/s; mom put pt to bed that AM checked noon not breathing;


VAERS ID: 57611 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:1993-10-07
Onset:1993-10-08
   Days after vaccination:1
Submitted: 1993-11-10
   Days after onset:33
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


VAERS ID: 57612 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:1993-10-23
Onset:1993-10-23
   Days after vaccination:0
Submitted: 1993-11-10
   Days after onset:18
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-23
   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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


VAERS ID: 57614 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1993-11-15
Onset:1993-11-17
   Days after vaccination:2
Submitted: 1993-11-19
   Days after onset:2
Entered: 1993-11-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 353905 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 348935 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy confirmed SIDS:
CDC Split Type:

Write-up: SIDS death on 17NOV93 sl fever since 16NOV93 APAP;


VAERS ID: 57658 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1993-10-29
Onset:1993-10-31
   Days after vaccination:2
Submitted: 1993-11-02
   Days after onset:2
Entered: 1993-11-24
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3B51020 / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06891 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Pallor, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Acetaminaphen;
Current Illness: NONE
Preexisting Conditions: Sickle cell trait;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5102

Write-up: Approximately 54 hrs p/DPT, OPV administered, infant was noted to suddenly be ashen & eventually inconsistable and died in 8 hrs; pathology report = pneumonia;


VAERS ID: 57668 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:1991-12-16
Onset:0000-00-00
Submitted: 1993-11-23
Entered: 1993-11-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES93110994

Write-up: pt recvd vax 16DEC91 & died from a heart attack;


VAERS ID: 57751 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1993-05-10
Onset:0000-00-00
Submitted: 1993-07-08
Entered: 1993-11-29
   Days after submission:144
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328933 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JC / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR9335

Write-up: NONE pt died 28JUN93 death dx SIDS; focal superficial hemorrhage of visceral surface of lungs w/focal low grade acute & chronic inflammation; hyperemia of liver; poss low grade resp tract infect of poss viral orgin;


VAERS ID: 57781 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1993-10-05
Onset:1993-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1993-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358918 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1226B2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358951 / 1 MO / PO

Administered by: Unknown       Purchased by: Private
Symptoms: Apnoea, Atelectasis, Condition aggravated, Haemorrhage, Lung disorder, Pyrexia, Sudden infant death syndrome, Weight decreased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-10-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tylenol;
Current Illness:
Preexisting Conditions: hx-took last dose of amox for ear infect 5OCT93;
Allergies:
Diagnostic Lab Data: no growth in 48 hrs on cultures;
CDC Split Type:

Write-up: pt died @ ER due to unk COD; pt had recently recvd vax; COD SIDS; dx visceral & pulmonary congestion; atelectasis; hemorrhages;


VAERS ID: 57806 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1993-11-17
Onset:1993-11-17
   Days after vaccination:0
Submitted: 1993-11-24
   Days after onset:7
Entered: 1993-11-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352923 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0690B / 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: 1993-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 57889 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1993-10-21
Onset:1993-10-24
   Days after vaccination:3
Submitted: 1993-12-02
   Days after onset:39
Entered: 1993-12-06
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41063 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1268A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686A / 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: 1993-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5134

Write-up: SIDS 3 days p/vax;


VAERS ID: 57896 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Iowa  
Vaccinated:1993-11-02
Onset:1993-11-04
   Days after vaccination:2
Submitted: 1993-11-08
   Days after onset:4
Entered: 1993-12-06
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1129W / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: mom was a drug user for the 1st & 2nd trimester; pt born premature & no prenatal care;
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA93032

Write-up: sudden unexplained infant death;


VAERS ID: 57905 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Michigan  
Vaccinated:1993-06-14
Onset:1993-06-15
   Days after vaccination:1
Submitted: 1993-09-20
   Days after onset:97
Entered: 1993-12-06
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


VAERS ID: 58039 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1993-08-12
Onset:1993-08-29
   Days after vaccination:17
Submitted: 1993-12-03
   Days after onset:96
Entered: 1993-12-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41062 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 682K6 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Haemorrhage, Lung disorder, 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: 1993-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH93023

Write-up: SIDS death;


VAERS ID: 58047 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1993-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: transverse myelitis;
Preexisting Conditions: hx of MS; hx optic neuritis 83, 84;
Allergies:
Diagnostic Lab Data: MR head & spine: nl;
CDC Split Type:

Write-up: pt exp MS vs Transverse myelitis; AUG92 rec hept vaccine; 1 wk later, paresthesias below waist, LE weak; Rx w/Prednisone;


VAERS ID: 58061 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1993-10-07
Onset:1993-10-12
   Days after vaccination:5
Submitted: 1993-11-16
   Days after onset:35
Entered: 1993-12-09
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC Split Type: MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


VAERS ID: 58089 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-10-25
Onset:1993-11-06
   Days after vaccination:12
Submitted: 1993-11-12
   Days after onset:6
Entered: 1993-12-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   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: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


VAERS ID: 58095 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: South Carolina  
Vaccinated:1993-11-02
Onset:1993-11-03
   Days after vaccination:1
Submitted: 1993-11-24
   Days after onset:21
Entered: 1993-12-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


VAERS ID: 58111 (history)  
Form: Version 1.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-12-08
Entered: 1993-12-10
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Dyspepsia, Hepatitis, Infection, Jaundice, Weight increased
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific dysfunction (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93110826

Write-up: pt recvd vax in 1990 & 1992 recvd another 3 doses w/no response; OCT93 devel indigestion; short time later devel severe jaundice & gained 40 pounds, presumed to be fluid in abdo; MD who examined state died of fulminant overwhelming hep B i;


VAERS ID: 58132 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-08
Onset:1993-10-28
   Days after vaccination:20
Submitted: 1993-11-16
   Days after onset:19
Entered: 1993-12-13
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, CSF test abnormal, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC Split Type: 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;


VAERS ID: 58135 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-12-07
Entered: 1993-12-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


VAERS ID: 58137 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-10-12
Onset:1993-10-14
   Days after vaccination:2
Submitted: 1993-12-07
   Days after onset:54
Entered: 1993-12-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor
SMQs:, Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


VAERS ID: 58157 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:1993-10-15
Onset:1993-10-23
   Days after vaccination:8
Submitted: 1993-11-29
   Days after onset:37
Entered: 1993-12-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


VAERS ID: 58232 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:1991-01-01
Submitted: 1993-12-10
   Days after onset:1074
Entered: 1993-12-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiac failure, Cardiomyopathy, Dyspnoea, Electrocardiogram abnormal, Hyperventilation, Infection, Myocarditis, Pleural effusion
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-10-10
   Days after onset: 281
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical hx: imperforate anus;
Allergies:
Diagnostic Lab Data: Chest x-ray JAN91: cardiomegaly/pleural effusion; ECG JAN91: cardiomegaly; ECG 18JAN91: voltage & T wave improvement; 13FEB91 ECG: extremely low voltage;
CDC Split Type: WAES93111107

Write-up: Pt recvd vax in FEB91 & devel cardiomyopathy & myocarditis; pt underwent a heart transplant; however, it was unsuccessful; 10OCT91 pt died;


VAERS ID: 58252 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Unknown  
Location: Texas  
Vaccinated:1993-12-06
Onset:1993-12-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1993-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41111 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356945 / 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: 1993-12-08
   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: Ventolin; Nzoral cream
Current Illness: diaper rash
Preexisting Conditions: bady had had bronchiolitis prior to visit but was well this visit;
Allergies:
Diagnostic Lab Data: Autopsy revealed no obvious cause of death
CDC Split Type:

Write-up: pt was found dead w/in 48 hrs of vax administration; preliminary investigation indicates probable SIDS;


VAERS ID: 58255 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-12-13
Entered: 1993-12-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1268A2 / 1 - / -

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:
CDC Split Type: 930046261

Write-up: pt recvd vax & 3 days later died @ home of SIDS; further details have been requested;


VAERS ID: 58266 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1993-11-23
Onset:1993-11-24
   Days after vaccination:1
Submitted: 1993-11-24
   Days after onset:0
Entered: 1993-12-16
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358918 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1243W / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 20682C / 2 MO / PO

Administered by: Public       Purchased by: Public
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: 1993-11-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: ?autopsy pending;
CDC Split Type: NYS93086

Write-up: pt found dead in crib in morning-cyanotic, lying on face on 24NOV93 (found by father);


VAERS ID: 58276 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Alabama  
Vaccinated:1993-11-02
Onset:1993-11-04
   Days after vaccination:2
Submitted: 1993-11-12
   Days after onset:8
Entered: 1993-12-17
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3A51135 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH MD1DJN / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356944 / 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: 1993-11-04
   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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL93048

Write-up: Sudden Infant Death; no autopsy done-death certificate said SIDS;


VAERS ID: 58301 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Jersey  
Vaccinated:1993-11-08
Onset:1993-11-11
   Days after vaccination:3
Submitted: 1993-11-11
   Days after onset:0
Entered: 1993-12-20
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352923 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358937 / 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: 1993-11-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: full-term vaginal delivery
Allergies:
Diagnostic Lab Data: autopsy performed (verbal report)-sids;
CDC Split Type: 930243201

Write-up: pt recvd vax 8NOV93 & was found dead 11NOV93; pt had not exp any side effect p/vax & appeared happy; autopsy performed-dx SIDS; infant was given prophylactic tylenol, had no post-vax rxns;


VAERS ID: 58319 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: Missouri  
Vaccinated:1993-10-22
Onset:1993-11-26
   Days after vaccination:35
Submitted: 1993-12-11
   Days after onset:15
Entered: 1993-12-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private       Purchased by: Other
Symptoms: Hepatic failure
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: acute hepatocellular failure;


VAERS ID: 58340 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Dakota  
Vaccinated:1993-11-10
Onset:1993-12-04
   Days after vaccination:24
Submitted: 1993-12-13
   Days after onset:9
Entered: 1993-12-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41063 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1518V / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0679M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Hepatomegaly, Lung disorder, Otitis media, Petechiae, Pharyngitis, Pulmonary oedema, Rhinitis, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unable to obtain @ this time;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy in progress to determine death;
CDC Split Type: ND93023

Write-up: pt had been treated for a cold & ear infect approx wk p/vax; vax given 10NOV93 pt died of SIDS 4DEC93;


VAERS ID: 58359 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-04
Onset:1993-10-15
   Days after vaccination:11
Submitted: 1993-11-24
   Days after onset:40
Entered: 1993-12-22
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Non-haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


VAERS ID: 58384 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:1993-10-13
Onset:1993-11-29
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41148 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Endocarditis, Haematemesis, Haemorrhage, Infection, Leukopenia, Lymphadenopathy, Necrosis, Pneumonia
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: waiting on drug screen
CDC Split Type: CO5196

Write-up: found dead in apartment, no suspicious circumstances. Autopsy results: lymphoma; no known cause of death.


VAERS ID: 58410 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:1993-12-14
Onset:1993-12-14
   Days after vaccination:0
Submitted: 1993-12-15
   Days after onset:1
Entered: 1993-12-27
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private       Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


VAERS ID: 58411 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maine  
Vaccinated:1993-12-15
Onset:1993-12-21
   Days after vaccination:6
Submitted: 1993-12-21
   Days after onset:0
Entered: 1993-12-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3B51020 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 691F5 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cyanosis, Hypothermia, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Accidents and injuries (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: found cold/blue/not breathing in crib, no response to resuscitation, presumed SIDS autopsy pending


VAERS ID: 58412 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1993-12-13
Onset:1993-12-19
   Days after vaccination:6
Submitted: 1993-12-20
   Days after onset:1
Entered: 1993-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP285 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M135KA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0684E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: apparent SIDS, child found dead in crib, baby had nasal congestion for 2 days prior to death


VAERS ID: 58550 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1993-11-24
Onset:1993-11-25
   Days after vaccination:1
Submitted: 1993-11-30
   Days after onset:5
Entered: 1993-12-29
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 353904 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 352940 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Hypoxia, Infection, Pneumonia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (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: 1993-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: healthy
Preexisting Conditions: full term, vaginal delivery; OM resolved 1 wk prior to immun; treated w/Amoxicillin;
Allergies:
Diagnostic Lab Data: autopsy: viral pneumonia-cultures pending;
CDC Split Type: 930252201

Write-up: pt recvd vax 24NOV93 & 7AM next day mom found pt not breathing; EMt called; pt resuscitated for approx 40 mins--was unsuccessful; MEDEVAC to hosp; pronounced DOA; autopsy-viral pneumonia;


VAERS ID: 58591 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1993-10-21
Onset:1993-11-16
   Days after vaccination:26
Submitted: 1993-12-27
   Days after onset:41
Entered: 1993-12-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51025 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0992W / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125KC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0687F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Encephalopathy, Hypoxia, Pneumonia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: 1993-11-16
   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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH93029

Write-up: 16NOV93 taken to hosp p/being found by sitter;


VAERS ID: 58817 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Female  
Location: Montana  
Vaccinated:1993-10-15
Onset:1993-10-25
   Days after vaccination:10
Submitted: 1993-12-27
   Days after onset:63
Entered: 1994-01-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / UNK - / IM A
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1043W / UNK - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0961W / UNK - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686B / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden death; atuopsy report-cause of death remains undetermined; The poss of a sudden arrhythmia based on a morphologic abnormality of the conducting system of the heart will be investigated further;


VAERS ID: 58826 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1993-12-23
Onset:1993-12-26
   Days after vaccination:3
Submitted: 1993-12-27
   Days after onset:1
Entered: 1994-01-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP285 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 09201O / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M135KA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668B / 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: 1993-12-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: GE reflux on thickened feeds
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS death 26DEC93; DTP administered 23DEC93;


VAERS ID: 58871 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-09-28
Onset:1993-12-18
   Days after vaccination:81
Submitted: 1994-01-03
   Days after onset:16
Entered: 1994-01-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC Split Type:

Write-up: respiratory failure, usual interstital pneumonia, death;


VAERS ID: 58884 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-10-14
Onset:1993-10-28
   Days after vaccination:14
Submitted: 1993-12-29
   Days after onset:62
Entered: 1994-01-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (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), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-27
   Days after onset: 30
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:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


VAERS ID: 58900 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New Hampshire  
Vaccinated:1993-10-13
Onset:1993-10-21
   Days after vaccination:8
Submitted: 1993-12-20
   Days after onset:60
Entered: 1994-01-10
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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: 1993-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH93028

Write-up: SIDS 21OCT93;


VAERS ID: 58909 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Michigan  
Vaccinated:1993-10-08
Onset:0000-00-00
Submitted: 1994-01-04
Entered: 1994-01-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1218B / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180KD / 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: 1993-10-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: troticllis-improving;
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: SIDS on 11OCT93;


VAERS ID: 58929 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New Mexico  
Vaccinated:1993-06-30
Onset:1993-10-04
   Days after vaccination:96
Submitted: 1994-01-06
   Days after onset:94
Entered: 1994-01-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1280T / 3 - / IM

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Bronchiolitis, Condition aggravated, Grand mal convulsion, Infection, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-12-24
   Days after onset: 81
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Phenobarbital, chlorazepam, phenytoin, carnitine, glycopyrrolate, nebulized albuterol;
Current Illness:
Preexisting Conditions: Neurological disorder, sz disorder; irregularity vertebral; plagiocephaly;
Allergies:
Diagnostic Lab Data: 04OCT93 blood cx: H. influenza, non-A non-B, positive;
CDC Split Type: WAES93120805

Write-up: Pt recvd vax & devel a HIB infect; exp was felt to be life threatening; addtl details are being requested;


VAERS ID: 58940 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1993-12-13
Onset:1993-12-14
   Days after vaccination:1
Submitted: 1994-01-05
   Days after onset:22
Entered: 1994-01-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / UNK - / IM L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1289B2 / UNK - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 354960 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Alkalosis, Blood urea increased, Dehydration, Diarrhoea, Hyperkalaemia, Muscle twitching, Shock, Stupor
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-15
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxil
Current Illness: very mild URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood glucose-10mgs; SMA6; Chlor 117; CO 215, POT 7.7, NA 156, GLUC 10, BUN 40; Stool cult x 2-no growth, Blood Culture-no growth;
CDC Split Type:

Write-up: mom notified office about pt''s condition about 18 hrs p/onset diarrhea; pt seen immed appeared to be in shock due to severe dehydration; mild jerking of extremities w/eyes fixed, skin dry & fontanel sunken;


VAERS ID: 58964 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Michigan  
Vaccinated:1993-11-17
Onset:0000-00-00
Submitted: 1994-01-04
Entered: 1994-01-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1218B / 2 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 128B2 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0692H / 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: 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: URI-1wk;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 59095 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1992-06-09
Onset:1992-06-24
   Days after vaccination:15
Submitted: 1993-12-07
   Days after onset:531
Entered: 1994-01-14
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 1031006 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0653K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SIDS dx @ autopsy;
CDC Split Type: TX93231

Write-up: died 15 days p/vax;


VAERS ID: 59120 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Arizona  
Vaccinated:1993-11-28
Onset:1993-12-11
   Days after vaccination:13
Submitted: 1993-12-21
   Days after onset:10
Entered: 1994-01-18
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938278 / UNK - / IM A

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Cardiovascular disorder, Dysphagia, Dyspnoea, Guillain-Barre syndrome, Neck pain, Neuropathy, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Demyelination (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: hx of labile hypertension, uterine cancer--rx''d in 1975, hysterectomy, osteoporosis, acute herniated disc--rx''d w/epidural blocks; allergic to sulfa drugs & possibly Demerol;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893357001J

Write-up: pt recvd flu vax 28NOV93 & approx 14DEC93 began to devel sx of GBS; remains hospitalized as the date of this report in stable condition;


VAERS ID: 59156 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:1993-10-01
Onset:1993-10-01
   Days after vaccination:0
Submitted: 1994-01-04
   Days after onset:95
Entered: 1994-01-18
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Peripheral neuropathy (narrow), Conduction defects (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


VAERS ID: 59182 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1992-04-03
Onset:1992-04-04
   Days after vaccination:1
Submitted: 1993-02-11
   Days after onset:313
Entered: 1994-01-20
   Days after submission:343
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316975 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700HL / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312916 / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Apnoea, Cerebral ischaemia, Myocardial ischaemia, Pain, Pneumonia, Somnolence, Thinking abnormal
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: wheezing & stuffy nose
Preexisting Conditions: milk allergy dx @ 10 dasy old
Allergies:
Diagnostic Lab Data: COD listed as undetermined autopsy showed pt had pneumonia on 1 lung;
CDC Split Type: OH94008

Write-up: about 7PM noticed was groggy & sl incoherant & crying & uncomfortable most of the evening; went to sleep @ 10PM; found not breathing 1210AM; never recovered; pronounced dead on 6APR92 about 5PM;


VAERS ID: 59231 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1994-01-06
Onset:1994-01-12
   Days after vaccination:6
Submitted: 1994-01-19
   Days after onset:7
Entered: 1994-01-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358986 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1311A2 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: blocked tear duck (dacryo stenosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found by parents AM not breathing, pale, warm; lips were blue & sl stiff; CPR was begun; monitor showed asystole; In ER found to be cold, stiff; extremities showed poor peripheral perfusion & no cap refill; SIDS;


VAERS ID: 59281 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated:1993-10-28
Onset:1993-10-28
   Days after vaccination:0
Submitted: 1993-11-15
   Days after onset:18
Entered: 1994-01-26
   Days after submission:72
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938149 / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Arrhythmia, Cardiac arrest, Cerebrovascular accident, Dyspnoea, Hypokalaemia, Hypoxia, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-28
   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: diabetes, hypokalema, COPD, old CVA
Preexisting Conditions: diabetes, hypokalemia, COPD, old CVA;
Allergies:
Diagnostic Lab Data: COD cardiorespiratory arrest secondary dx CVA, arrythmia; K-3.3; Creat 0.5; WBC 9.6; HCT 39.0; PO2 48.8; PC02 46.0;
CDC Split Type: AL9353

Write-up: pt recvd vax & pt did not feel well; denies chest pain; phone call from family @ 345; pt having trouble breathing; instructed to call 911 or transport to ER arrived ER 444PM; PO2 48.8, Co2 46.0; K 3.3; creact 5; resp sx cont to worsen;


VAERS ID: 59293 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1993-11-29
Onset:1994-01-12
   Days after vaccination:44
Submitted: 1994-01-14
   Days after onset:2
Entered: 1994-01-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 356912 / UNK RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1151A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010JN / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 354962 / UNK 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: 1994-01-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pt recvd Hep B vax 27SEP93;
Current Illness: diaper rash only
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: Pt died of SIDS 12JAN94; autopsy done 12JAN94;


VAERS ID: 59322 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: South Carolina  
Vaccinated:1993-11-30
Onset:1993-12-10
   Days after vaccination:10
Submitted: 1993-12-13
   Days after onset:3
Entered: 1994-01-27
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0942W / 1 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Cyst, Haemorrhage, Lung disorder, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: SC949

Write-up: NA


VAERS ID: 59397 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Oregon  
Vaccinated:1993-11-05
Onset:1994-01-06
   Days after vaccination:62
Submitted: 1994-01-12
   Days after onset:6
Entered: 1994-01-31
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41071 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 342963 / 2 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: 1994-01-06
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: pt died of SIDS 6JAN93 p/hosp attempt to revive; case #940067; Autopsy done 7JAN94;


VAERS ID: 59398 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Indiana  
Vaccinated:1993-12-07
Onset:1994-01-07
   Days after vaccination:31
Submitted: 1994-01-20
   Days after onset:13
Entered: 1994-01-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed-results pending;
CDC Split Type:

Write-up: Full arrest went to ER; pronounced dead 0958;


VAERS ID: 59399 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Indiana  
Vaccinated:1993-12-17
Onset:1994-01-12
   Days after vaccination:26
Submitted: 1994-01-20
   Days after onset:8
Entered: 1994-01-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / 2 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356940 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Septra
Current Illness: BSOM improving;
Preexisting Conditions: bilateral serous OM;
Allergies:
Diagnostic Lab Data: autopsy consistent w/SIDS;
CDC Split Type:

Write-up: pronounced dead ER;


VAERS ID: 59427 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: California  
Vaccinated:1993-12-06
Onset:1993-12-08
   Days after vaccination:2
Submitted: 1994-01-25
   Days after onset:48
Entered: 1994-02-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342972 / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686A / 1 - / -

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: 1993-12-08
   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: NONE
Preexisting Conditions: extreme SGA
Allergies:
Diagnostic Lab Data: normal labs;
CDC Split Type:

Write-up: SIDS prenatal street drug exposure; very SGA high risk home;


VAERS ID: 59428 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1994-01-07
Onset:1994-01-09
   Days after vaccination:2
Submitted: 1994-01-24
   Days after onset:15
Entered: 1994-02-02
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342972 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1300W / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150KC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686A / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: prenatal street drug exposed; In foster care;
Allergies:
Diagnostic Lab Data: clinical SIDS; pneumonitis @ Autopsy;
CDC Split Type:

Write-up: found dead in bed;


VAERS ID: 59429 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1993-09-21
Onset:1993-09-25
   Days after vaccination:4
Submitted: 1994-01-25
   Days after onset:122
Entered: 1994-02-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 342972 / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-25
   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:
Preexisting Conditions: premie @ 29 wks; prenatal street drug exposure;
Allergies:
Diagnostic Lab Data: 02 sats nl;
CDC Split Type:

Write-up: SIDS 25SEP93 family homeless & living in van; on 02 until wk a/death;


VAERS ID: 59506 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:1993-10-26
Onset:1993-11-08
   Days after vaccination:13
Submitted: 1993-11-19
   Days after onset:11
Entered: 1994-02-03
   Days after submission:76
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358986 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 690E3 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Infection, Influenza, Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   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: Amoxicillin & taking non-ASA pain reliever;
Current Illness: viral influenza sxs;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR9364

Write-up: died of SIDS; pt was suffering from viral influenza sx; mom described as vomiting the previous day; flu-like sx;


VAERS ID: 59693 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1993-01-22
Onset:0000-00-00
Submitted: 1993-03-12
Entered: 1994-02-04
   Days after submission:329
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2K31068 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105JJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 338925 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-01-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Following vax, pt had become sl feverish & irritable, given APAP;


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