|
VAERS ID: |
27141 (history) |
Form: |
Version 1.0 |
Age: |
84.0 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 1990-10-22 |
Onset: | 1990-10-22 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-12-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
287974 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Nausea,
Pain SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-25
Days after onset: 3
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: rash /w penicillin Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died |
|
VAERS ID: |
27153 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Unknown |
Location: |
Ohio |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1990-12-05 |
Entered: |
1990-12-21 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / UNK |
- / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
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: 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: CO3729
Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection. |
|
VAERS ID: |
27159 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
North Carolina |
Vaccinated: | 1990-11-26 |
Onset: | 0000-00-00 |
Submitted: |
1990-12-17 |
Entered: |
1990-12-26 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
OF11208 / UNK |
- / - |
Administered by: Private Purchased by: Public Symptoms: Bronchitis,
Cough,
Influenza SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-12
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA) Current Illness: ganglion wrist Preexisting Conditions: Penicillin by hx Allergies: Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative CDC Split Type:
Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later. |
|
VAERS ID: |
27160 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-12-18 |
Onset: | 1990-12-18 |
Days after vaccination: | 0 |
Submitted: |
1990-12-19 |
Days after onset: | 1 |
Entered: |
1990-12-26 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / 2 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M730FE / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0615A / 2 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-18
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: Caldesene cream Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/HIB expired 7 hrs later. Dx SIDS. |
|
VAERS ID: |
27161 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1990-12-11 |
Onset: | 1990-12-12 |
Days after vaccination: | 1 |
Submitted: |
1990-12-17 |
Days after onset: | 5 |
Entered: |
1990-12-26 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB |
DTP272 / UNK |
LL / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M190FD / UNK |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287952 / UNK |
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: 1990-12-12
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS. |
|
VAERS ID: |
27246 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 1990-12-14 |
Onset: | 1990-12-15 |
Days after vaccination: | 1 |
Submitted: |
1990-12-17 |
Days after onset: | 2 |
Entered: |
1990-12-31 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271916 / 2 |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287951 / 2 |
MO / PO |
Administered by: Private Purchased by: Other Symptoms: Cyanosis,
Hypotonia,
Sudden infant death syndrome SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-15
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: This was an adopted infant born at Tacoma General Hosp Allergies: Diagnostic Lab Data: CDC Split Type: WA90499
Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS |
|
VAERS ID: |
27275 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 1990-11-26 |
Onset: | 1990-11-26 |
Days after vaccination: | 0 |
Submitted: |
1990-12-26 |
Days after onset: | 30 |
Entered: |
1991-01-02 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01870P / UNK |
LA / IM |
Administered by: Other Purchased by: Other 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: 1990-11-26
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ascriptin, Metamucil Current Illness: Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired. |
|
VAERS ID: |
27309 (history) |
Form: |
Version 1.0 |
Age: |
0.18 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-12-06 |
Onset: | 1990-12-12 |
Days after vaccination: | 6 |
Submitted: |
1990-12-21 |
Days after onset: | 9 |
Entered: |
1991-01-04 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
291930 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
285951 / UNK |
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: 1990-12-12
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Pathology report by Hosp. CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV sudden infant death. |
|
VAERS ID: |
27313 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Male |
Location: |
West Virginia |
Vaccinated: | 1989-07-17 |
Onset: | 1990-12-03 |
Days after vaccination: | 504 |
Submitted: |
1990-12-27 |
Days after onset: | 24 |
Entered: |
1991-01-07 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8J01171 / 1 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Drug ineffective,
Immune system disorder,
Meningitis,
Sepsis SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-05
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Blood Culture positive for H. Influenza type B CDC Split Type: CO3731
Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency. |
|
VAERS ID: |
27341 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-12-27 |
Onset: | 1990-12-29 |
Days after vaccination: | 2 |
Submitted: |
1991-01-03 |
Days after onset: | 5 |
Entered: |
1991-01-08 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283910 / UNK |
- / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M6507B / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
06137 / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Cyanosis SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-29
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib. |
|