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VAERS ID: 59714 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-12-16
Onset:1994-01-06
   Days after vaccination:21
Submitted: 1994-01-18
   Days after onset:12
Entered: 1994-02-07
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 348982 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1436V / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0688H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Right ventricular failure, Stupor
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: oral thrush
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: NC94007

Write-up: pt was brought into hosp by mom was unresponsive on arrival to ER:


VAERS ID: 59746 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Utah  
Vaccinated:1994-01-04
Onset:1994-01-15
   Days after vaccination:11
Submitted: 1994-02-02
   Days after onset:18
Entered: 1994-02-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358986 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: stuffy nose-afebrile
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: over 10 days pt had stuffy nose & then devel a cough; 3 to 4 days prior to death became febrile; had poor suckle 15JAN94 was noted to be dusky in crib; pt was picked up, cried out & then stopped breathing;


VAERS ID: 59749 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Florida  
Vaccinated:1994-01-21
Onset:1994-01-25
   Days after vaccination:4
Submitted: 1994-01-31
   Days after onset:6
Entered: 1994-02-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362955 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Cardiac arrest, Congenital anomaly, Delirium, Hepatic steatosis, Personality disorder, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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), Dementia (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bactrim susp; Rynastan
Current Illness: serous otitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy revealed fatty infiltration of fever suggesting REYES synd further tests pending;
CDC Split Type:

Write-up: Pt recvd vax 21JAN94; PE WNL; vomiting began 24JAN93 w/some min. behavioral change, loss of appetite; arrived in ER early 25JAN94 in full cardiac arrest resusitation attempts failed;


VAERS ID: 59767 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:1993-04-01
Onset:1993-09-13
   Days after vaccination:165
Submitted: 1993-12-15
   Days after onset:93
Entered: 1994-02-09
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0139A / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-13
   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: NA~ ()~~~In patient
Other Medications: NA
Current Illness:
Preexisting Conditions: born prematurely @ 32 wks gestation; suffered numerous minor infect in the past;
Allergies:
Diagnostic Lab Data: post mortem showed HIB meningitis; sample of serum showed no antibody against HIB;
CDC Split Type: 940012601

Write-up: pt died 13SEP93; post mortem showed HIB meningitis & sample of serum showed no antibody against HIB;


VAERS ID: 59828 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: Georgia  
Vaccinated:1993-10-07
Onset:1993-10-21
   Days after vaccination:14
Submitted: 1993-11-19
   Days after onset:29
Entered: 1994-02-14
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (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: 1993-11-09
   Days after onset: 19
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


VAERS ID: 59884 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1994-02-04
Onset:1994-02-07
   Days after vaccination:3
Submitted: 1994-02-07
   Days after onset:0
Entered: 1994-02-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / 1 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1269A4 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0682M / 1 MO / PO

Administered by: Unknown       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: 1994-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Albuterol syrup
Current Illness: URI (probable viral)
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt seen in ER in full arrest & expired;


VAERS ID: 59922 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Georgia  
Vaccinated:1994-02-09
Onset:1994-02-10
   Days after vaccination:1
Submitted: 1994-02-11
   Days after onset:1
Entered: 1994-02-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / 3 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358952 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Gastrointestinal disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-10
   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: poss gastroesophageal reflux
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt vomited @ daycare & apparently had resp arrest; code red began in daycare & pt transported to hosp ER where resusitation was unsuccessful;


VAERS ID: 59982 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1994-01-14
Onset:1994-01-22
   Days after vaccination:8
Submitted: 1994-02-11
   Days after onset:20
Entered: 1994-02-22
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 0339A / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0414W / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010KD / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691C / 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: 1994-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX9443

Write-up: pt was examined on 14JAN94 & found to be in good hlth; pt recvd vax 14JAN94 & 22JAN94 died of crib death according to the mom; atuopsy results pending; no fever or other sx noted p/vax;


VAERS ID: 60026 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1993-04-21
Onset:1993-04-23
   Days after vaccination:2
Submitted: 1994-01-10
   Days after onset:262
Entered: 1994-02-24
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41073 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120JJ / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 342967 / 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: 1993-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NNE
Allergies:
Diagnostic Lab Data: SIDS death coroners final dx 3JUN93;
CDC Split Type: CA94019

Write-up: asymptomatic found pt blue & cold in bed in early AM day following immun; called 911; pt apparently had been dead for several hrs;


VAERS ID: 60091 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1994-02-04
Onset:1994-02-14
   Days after vaccination:10
Submitted: 1994-02-17
   Days after onset:3
Entered: 1994-02-28
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3B51020 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1436V / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M495JK / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358944 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rhinitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mycostat; APAP
Current Illness: thrush
Preexisting Conditions: poor growth
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: temp to 105 PM of 4FEB & off & on until 6FEB; no redness or swelling of inject site; no excessive/high pitched cry; afebrile 7FEB-14FEB; mild runny nose 7FEB-14FEB;


VAERS ID: 60263 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-02-18
Onset:1994-02-21
   Days after vaccination:3
Submitted: 1994-02-22
   Days after onset:1
Entered: 1994-03-04
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1114A2 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: mild URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died 2 1/2 days p/vax; mom went to feed pt & found pt dead;


VAERS ID: 60303 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Massachusetts  
Vaccinated:1993-10-12
Onset:1993-10-14
   Days after vaccination:2
Submitted: 1993-10-15
   Days after onset:1
Entered: 1994-03-07
   Days after submission:143
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP284B / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010JN / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0683C / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Congenital anomaly, Congenital central nervous system anomaly, Congenital genitourinary abnormality, Congenital musculoskeletal anomaly, Gastrointestinal malformation, Multiple congenital abnormalities, Pulmonary haemorrhage, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Congenital, familial and genetic disorders (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-14
   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: Tagament
Current Illness: no acute illness;
Preexisting Conditions: Arthrogryposis multiplex, Colpocephaly, esophageal dysmotility;
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: resp arrest;


VAERS ID: 60304 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1992-05-27
Onset:1992-06-12
   Days after vaccination:16
Submitted: 1994-02-12
   Days after onset:610
Entered: 1994-03-07
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2G31010 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0178V / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312923 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Dementia, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-10-14
   Days after onset: 489
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: workup for sz-no etiol found; autopsy inconclusive;
CDC Split Type:

Write-up: pt recvd vax 27MAY92 & 12JUN92 devel fever, then status epilepticus, sz persistently w/brain atrophy & severe developmental delay;;


VAERS ID: 60638 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1994-02-24
Onset:0000-00-00
Submitted: 1994-03-03
Entered: 1994-03-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1414W / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 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: 1994-03-03
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mom stated on no meds on contraindication checklist;
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL94011

Write-up: pt was born 22-33wks gestation; Discharged on 7JAN94 dx listed are prematurity, ROS vs TTN w/resp failure, hyperbilinbinemia, apnea &bradycardia, chalasia, suspected small lt intercranial hemorrhage w/mild ventriculomegaly;


VAERS ID: 60665 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1994-02-23
Onset:1994-02-24
   Days after vaccination:1
Submitted: 1994-03-04
   Days after onset:8
Entered: 1994-03-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366948 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 360937 / 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: 1994-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NOE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report-sudden infant death;
CDC Split Type:

Write-up: death;


VAERS ID: 60704 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1994-01-24
Onset:1994-01-30
   Days after vaccination:6
Submitted: 1994-03-11
   Days after onset:40
Entered: 1994-03-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358919 / 1 - / IM L
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1287B2 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0694H / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Electroencephalogram abnormal, Hypertonia, Hypotonia, Nuchal rigidity, Respiratory disorder, Salivary hypersecretion, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: premature baby
Allergies:
Diagnostic Lab Data: MRI test results nl; EEG test recorded abn brain wave activity;
CDC Split Type:

Write-up: 1st 5 days pt was pale white, not responsive, limp; 6th day sz began eyes twitching, drooling, tight fists, heavy & loud (snoring sound) breathing, stiff neck, staring spells


VAERS ID: 60715 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:1993-10-08
Onset:1993-11-04
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 1994-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome, Pain
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: HCTZ
Current Illness:
Preexisting Conditions: large cell lymphoma of abdo; dx SEP93 treated w/ 3 cycles of meds; ASCVD, MI
Allergies:
Diagnostic Lab Data: CSF protein inc @ 155;
CDC Split Type:

Write-up: Pt exp GBS secondary to flu vax given 8OCT93; since the vax pt had exp 2-3 wks of upper body discomfort & weakness;


VAERS ID: 60732 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-03-09
Entered: 1994-03-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Hepatic function abnormal, Hepatic necrosis, Hepatic steatosis, Hepatomegaly, Infection, Leukopenia, Pneumonia
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haematopoietic leukopenia (narrow), Lack of efficacy/effect (narrow), Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Otitis media; Eczema; Pneumonia; fever; prematurity; Immunologic disorder;
Allergies:
Diagnostic Lab Data: Blood teste neg; Urine screen neg; Serum transaminases elevated; serum bilirubin elevated; liver biopsy panzonal fatty change, cholestas; bone marrow exam grew measles virus; autopsy multinucleated cells; autospy lymphocyte depletion;
CDC Split Type: WAES94020934

Write-up: Pt recvd vax & exp fever of 38.9, diarrhea, scaling erythematous rash, oral candidiasis & an enlarged liver 98cm); lab results revealed elevated alkaline phosphatase, gamma-glutamyl transferase, aspartate aminitransferase;


VAERS ID: 60744 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: South Carolina  
Vaccinated:1993-09-24
Onset:1993-09-25
   Days after vaccination:1
Submitted: 1994-03-08
   Days after onset:164
Entered: 1994-03-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358919 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346930 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Dementia, Electroencephalogram abnormal, Grand mal convulsion, Laboratory test abnormal, Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: inc sz activity beginning 30 hrs p/vax; pt hospitalized & cont to have sz;


VAERS ID: 60833 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Missouri  
Vaccinated:1994-02-15
Onset:1994-02-15
   Days after vaccination:0
Submitted: 1994-02-18
   Days after onset:3
Entered: 1994-03-21
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 353922 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1283A2 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0694E / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Aortic valve stenosis, Arrhythmia, Atrial septal defect, Cardiovascular disorder, Congenital anomaly, Hypertrophy, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-15
   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: Lasix;
Current Illness:
Preexisting Conditions: aortic stenosis- pt had undergone balloon catheterization-not completely successful; pt was to have further procedures to correct heart problem in the future-were waiting for pt to get older;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 940033301

Write-up: Pt recvd vax 15FEB94 & was fussier than nl in evening; taken to ER w/abn ventricular thythm; died between 15FEB-PM & 16FEB-AM; h/o aortic stenosis; prev underwent ballon catherization-not completely successful;


VAERS ID: 60834 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-02-15
Onset:1994-02-17
   Days after vaccination:2
Submitted: 1994-02-25
   Days after onset:8
Entered: 1994-03-21
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366946 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt was fussy & irritable w/1st & 2nd immunization;~ ()~~0.00~Patient
Other Medications: NA
Current Illness:
Preexisting Conditions: had 2 sz episodes of flu during the 4 wks prior to immunization & recvd 2 courses of ATB;
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS (brain and heart normal)
CDC Split Type: 9400361

Write-up: w/in 48 hrs of vax pt died-17FEB94; preliminary autopsy report indicates SIDS (brain and heart nl). culture are pending; grandparent states that pt had 2 episodes of flu during the 4 wks prior to immun & had recvd 2 courses of ATB;


VAERS ID: 60911 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Washington  
Vaccinated:1994-02-11
Onset:1994-02-23
   Days after vaccination:12
Submitted: 1994-03-01
   Days after onset:6
Entered: 1994-03-21
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350915 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KD / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0692C / 2 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), 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: 1994-02-23
   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: NONE
Preexisting Conditions: physician had cleared for 2nd set of immun;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WA941010

Write-up: pt found dead in crib early AM had been sick w/cold & diarrhea; had seen MD x 2 for these; had viral meningitis w/sz 28DEC94-hospitalized;


VAERS ID: 61007 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: D.C.  
Vaccinated:1994-02-25
Onset:1994-02-26
   Days after vaccination:1
Submitted: 1994-03-08
   Days after onset:10
Entered: 1994-03-25
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358919 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0692H / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: preliminary autopsy report
CDC Split Type:

Write-up: Pt is a 4mo, male seen @ Peds clinic for regular 4mo well baby check. Had no fever on visit. Normal PE. Recvd vaxs, reported to have died on following day at 3:00PM. Had temp to 104.4 @ death.


VAERS ID: 61045 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Indiana  
Vaccinated:1994-02-11
Onset:1994-02-15
   Days after vaccination:4
Submitted: 1994-03-07
   Days after onset:20
Entered: 1994-03-28
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51044 / 4 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691L / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Blood urea increased, Brain oedema, Hepatic failure, Hypertonia, Hypoglycaemia, Leukocytosis, Pharyngitis, Pyrexia
SMQs:, Acute renal failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-19
   Days after onset: 4
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: drug screen neg; amoa gap 20; glucose 23; BUN 36.7; WBC 22; 87 neut; lymph 8.8, 0.9 MON, 19.2 neut; cerebral edema hepatic failure;
CDC Split Type: IN94003

Write-up: 15FEB pt became ill cold like sx; t103 3AM lower limbs stiffness; 1015 ER comatase, listless, tonic posturing, decerebrate posturing of fore arms; WBC 22,000; BUN 33; P202-602;


VAERS ID: 61058 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:1992-10-12
Onset:1992-11-12
   Days after vaccination:31
Submitted: 1994-03-09
   Days after onset:482
Entered: 1994-03-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Nuchal rigidity, Peroneal nerve palsy, Pruritus, Speech disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dementia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (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? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC Split Type:

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


VAERS ID: 61135 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1994-02-22
Onset:0000-00-00
Submitted: 1994-02-26
Entered: 1994-03-30
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3A51135 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180KB / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0689P / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-25
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: del c-Sect;
Allergies:
Diagnostic Lab Data: None in Er; Autopsy was performed; toxicology & microscopic reports pending;
CDC Split Type: TX9454

Write-up: mom states pt ran a little fever afterwards, reported 25FEB94 well baby check @ MD''s office; ran fever, unmeasured that noc; discovered not breathing 26FEB94 AM @ 6AM cold to touch, blue, fingers stiff, eyes fixed & dialated;


VAERS ID: 61144 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Texas  
Vaccinated:1994-01-29
Onset:1994-01-30
   Days after vaccination:1
Submitted: 1994-03-14
   Days after onset:43
Entered: 1994-03-30
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KD / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362947 / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hepatic steatosis
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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: 1994-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bactrim, Tavist
Current Illness: OM
Preexisting Conditions: Cleft palate per autopsy report;
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX9463

Write-up: pt presented to ER in cardiopulmonary arrest 30JAN04; apparently occured 25-30min; prior to showing @ hosp; attempted CPR unsuccessfully; pt cold extremities, no activity on arrival to ER; final coroners report SIDS;


VAERS ID: 61625 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Alabama  
Vaccinated:1993-12-09
Onset:1993-12-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / 3 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac, chloral hydrate, antihistamine;
Current Illness: patent ductus arteriosus
Preexisting Conditions: Oligosyndactyly, Cornelia De Lange Synd, Micropenis, Hypospadias, Micrognathia, Congenital joint contractures, Microcephaly, Ambiguous genitalia, Hearing Deficit, S/P Gastrostomy;
Allergies:
Diagnostic Lab Data: pt seen & treated by ER MD;
CDC Split Type:

Write-up: cardiovascular collapse secondary to apnea-SIDS;


VAERS ID: 64533 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-09-20
Onset:1993-09-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-05
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 47 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC Split Type: 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


VAERS ID: 61682 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-03-21
Onset:1993-03-21
   Days after vaccination:0
Submitted: 1994-04-05
   Days after onset:379
Entered: 1994-04-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 2J41015 / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Anorexia, Confusional state, Crying, Hypotonia, Muscle spasms, Muscle twitching, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-20
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fx humerus
Preexisting Conditions: CHF (under control); Chrone''s disease (under control);
Allergies:
Diagnostic Lab Data: devel infect from chronic foley, treated; then exotic inf, systemic mycotic infect;
CDC Split Type:

Write-up: temp couple hrs p/vax; disoriented, abt wk, 10 days later not eating, became cranky, abt 2 wks later unusual high pitched crying, moaning, twitching, spasms; limp & unresponsive & staring;


VAERS ID: 61695 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New York  
Vaccinated:1983-12-05
Onset:1983-12-05
   Days after vaccination:0
Submitted: 1994-03-17
   Days after onset:3755
Entered: 1994-04-11
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1983-12-05
   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: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 940055101

Write-up: Pt reportedly died in 1983 following the administration of Tri-Immunol; lot# was not recorded; No further clinical details available;


VAERS ID: 61720 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Mississippi  
Vaccinated:1994-01-20
Onset:0000-00-00
Submitted: 1994-04-04
Entered: 1994-04-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0301W / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130KE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 35294 / 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: 1994-01-29
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: mitral valve insuff to MD;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS94013

Write-up: was notified by mom that pt died 29JAN94 SIDS;


VAERS ID: 61764 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:1992-09-21
Submitted: 1994-02-16
   Days after onset:513
Entered: 1994-04-12
   Days after submission:54
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Epistaxis, Haemorrhage, Petechiae, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-11
   Days after onset: 508
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: Diurel, Lopressor
Current Illness:
Preexisting Conditions: Malignant polyp of Colon 20 year ago no recurrence; HTN
Allergies:
Diagnostic Lab Data: Marrow biopsy neg for leukemia; 16SEP WBC 4.5; plts 26; plts inc to 350 by 30SEP92;
CDC Split Type:

Write-up: Thrombocytopenia purpura onset several wks p/inject of hepatitis B vax; refractory steroids-splenctomy done on 21SEP92; Initial sx: petechial of extremities & mucosa bleeding from now & mouth;


VAERS ID: 61772 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-01-03
Entered: 1994-04-12
   Days after submission:98
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: Unknown       Purchased by: Unknown
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
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Coumaden, Potassium, Lanoxin;
Current Illness:
Preexisting Conditions: hx heart disease-MI 1SEP93; OCT93 congestive heart failure; SEP93 bypass surgery;
Allergies:
Diagnostic Lab Data: Chest XR; lung biopsy;
CDC Split Type:

Write-up: following flu vax & pneumonia devel resp failure; lung biopsy-usual interstital pneumonitis; died 18DEC93;


VAERS ID: 61854 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-12-16
Onset:1993-12-21
   Days after vaccination:5
Submitted: 1994-01-10
   Days after onset:20
Entered: 1994-04-18
   Days after submission:97
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3H41043 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010JN / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0682L / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injury, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA93203

Write-up: 21DEC93 mom found pt unresponsive father attempted CPR until rescue team arrived pronounced dead at hosp @ 137PM; was reported to SIDs center as poss SIDS; sl cold p/DTP;


VAERS ID: 61884 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oklahoma  
Vaccinated:1994-04-04
Onset:1994-04-06
   Days after vaccination:2
Submitted: 1994-04-13
   Days after onset:7
Entered: 1994-04-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 358915 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 134132 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 362902 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt found unresponsive by parents-ambulance called @ 0500-ambulance arrived 0512, CPR in porgress per family member-transported to hosp; DOA per ER MD was intubated & given EPI enroute;


VAERS ID: 61889 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: New Mexico  
Vaccinated:1993-08-20
Onset:1993-08-23
   Days after vaccination:3
Submitted: 1994-03-08
   Days after onset:197
Entered: 1994-04-18
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 344912 / 1 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M1455K / 3 - / L

Administered by: Private       Purchased by: Other
Symptoms: Condition aggravated, Laboratory test abnormal, Subdural haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-09-02
   Days after onset: 10
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: pt exp sz subdural hematoma @ 4mos w/OPV/Tetramune #2 dose;~ ()~~~In patient
Other Medications: Phenobarbitol
Current Illness: sz disorder-resolving subdural hematoma
Preexisting Conditions: heart murmur VSD
Allergies:
Diagnostic Lab Data: CT Scan-massive hemmhorage-MRI-massive hemmhorage;
CDC Split Type:

Write-up: 3 days p/vax pt was taken for a f/u CT Scan which showed a new massive subdural hematoma resulting in craniotomy & death;


VAERS ID: 61895 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1994-04-06
Onset:0000-00-00
Submitted: 1994-04-08
Entered: 1994-04-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER TR1221A / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1321B2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150KC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696A / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: pt recvd vax & was found by mom less than 1 hr later w/o pulse/resp; healthy prior to event per mom; transported to hosp ER; coroner declared death as SIDS;


VAERS ID: 61943 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1994-01-14
Onset:0000-00-00
Submitted: 1994-01-17
Entered: 1994-04-20
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352915 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Infection, Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-01-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NA
Preexisting Conditions: NUK
Allergies:
Diagnostic Lab Data: Autopsy shows Group D Entercococcus (streptococcus) Sepsis;
CDC Split Type: GA94010

Write-up: mom stated NKA or sickness in last 24 hrs; pt was well-hydrated, alert, responsive, showed no s/s of sickness; mom voiced an understanding immun instructions;


VAERS ID: 62010 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:1993-08-25
Onset:1993-08-25
   Days after vaccination:0
Submitted: 1994-04-19
   Days after onset:237
Entered: 1994-04-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiac failure, Diarrhoea, Hyperventilation, Infection, Myocarditis, Oedema peripheral, Pneumonia, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-09-10
   Days after onset: 16
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SEP93 Culture Enterobacter Cloacae
CDC Split Type: WAES94031491

Write-up: Pt recvd vax & 2 hrs later pt''s leg was swollen to the size of a nickel & had a sl fever; pt then developed sl diarrhea & was taken to ER-dehydration; pt vomited; appeared to be in colic-like pain; breathing was rapid & fever 104; bluish


VAERS ID: 62032 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Georgia  
Vaccinated:1994-01-25
Onset:0000-00-00
Submitted: 1994-02-15
Entered: 1994-04-22
   Days after submission:65
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352915 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 110KA / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686M / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-09
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: GA94021

Write-up: NONE died; pending due to possible suffocation mom states found pt dead;


VAERS ID: 62036 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1994-02-11
Onset:0000-00-00
Submitted: 1994-02-24
Entered: 1994-04-22
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352915 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0937W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686M / 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: 1994-02-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94025

Write-up: waiting on death cert;


VAERS ID: 62037 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Georgia  
Vaccinated:1994-01-05
Onset:1994-02-06
   Days after vaccination:32
Submitted: 1994-03-01
   Days after onset:23
Entered: 1994-04-22
   Days after submission:51
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0937W / 2 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Injury
SMQs:, Acute central respiratory depression (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-06
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94026

Write-up: on 6FEB94 died of asphyxia;


VAERS ID: 62066 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1994-04-12
Onset:1994-04-17
   Days after vaccination:5
Submitted: 1994-04-18
   Days after onset:1
Entered: 1994-04-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369907 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1329B2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 699M5 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Petechiae, Stupor, Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC94056

Write-up: pt found unresponsive w/o respiration rushed to hosp-pronounced DOA: pt found lying face down in vomitus w/o respiration rushed to ER-pronounced DOA:


VAERS ID: 62089 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Vermont  
Vaccinated:1994-04-18
Onset:1994-04-19
   Days after vaccination:1
Submitted: 1994-04-19
   Days after onset:0
Entered: 1994-04-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3E51112 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M675KN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of fetal tachycardia; s/p neonatal jaundice, s/p neg r/o sepsis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt had physical & 2 mo immun on 18APR; pt died on 19APR94-was sleeping on mattress between parents on back w/pillow under head;


VAERS ID: 62249 (history)  
Form: Version 1.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:1994-04-24
Onset:1994-04-24
   Days after vaccination:0
Submitted: 1994-04-25
   Days after onset:1
Entered: 1994-05-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J51047 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Shock, Stupor
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-24
   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: NONE
Preexisting Conditions: heart problems, overwieght;
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX94094

Write-up: pt recvd vax & approx 15-20 mins p/shot collapsed started convulsing; EMS took to hosp unresponsive when arrived;


VAERS ID: 62265 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1994-03-16
Onset:1994-03-18
   Days after vaccination:2
Submitted: 1994-04-22
   Days after onset:34
Entered: 1994-05-02
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366949 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0695M / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiovascular disorder
SMQs:, Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: pt appeared-fairly good health;
Preexisting Conditions: 32-38wk AGA 1.8 kg; perimembranous VSD; hypospadias & UPJ
Allergies:
Diagnostic Lab Data: NONE available/NONE collected;
CDC Split Type:

Write-up: pt found apneic & pulseless 18MAR94 AM; vax had been administered 16MAR94;


VAERS ID: 62418 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1994-03-16
Onset:1994-03-28
   Days after vaccination:12
Submitted: 1994-04-29
   Days after onset:31
Entered: 1994-05-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1221B / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0991W / 1 GM / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180KB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691B / 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: 1994-03-28
   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: Ventolin
Current Illness:
Preexisting Conditions: mild bronchospasm;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MI94036

Write-up: pt taken to hosp per conversation of Father to clinic & was pronounced dead;


VAERS ID: 62419 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Michigan  
Vaccinated:1994-04-20
Onset:1994-04-26
   Days after vaccination:6
Submitted: 1994-04-28
   Days after onset:2
Entered: 1994-05-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1321B2 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0642K / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-26
   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: Captopril, Lasix, Lanoxin, Aldactone, Amoxicillin, ASA;
Current Illness: NONE
Preexisting Conditions: hypoplastic lt heart- s/p stage 1 repair; asplenia;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & 5 days p/vax exp inc irritability; afebrile; no evidence of sepsis or breakdown of surgical repair; doubt relationship of demise to vax but due to proximity, felt necessary to report;


VAERS ID: 62422 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:1993-10-05
Onset:1993-10-08
   Days after vaccination:3
Submitted: 1994-04-29
   Days after onset:203
Entered: 1994-05-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Endocarditis, Infection, Influenza
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-24
   Days after onset: 167
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: began having periodic flu like dx 3 days p/vax & cont on & off until pt died; from viral endocarditis;


VAERS ID: 62447 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Massachusetts  
Vaccinated:1994-02-07
Onset:1994-02-20
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1994-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0992W / 2 RL / 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: 1994-02-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94012

Write-up: SIDS


VAERS ID: 62482 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Male  
Location: Kansas  
Vaccinated:1993-08-10
Onset:0000-00-00
Submitted: 1994-05-03
Entered: 1994-05-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1614V / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Back pain, Cholecystitis, Headache, Influenza, Neoplasm malignant, Pseudo lymphoma, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES94040554

Write-up: pt recvd vax 10AUG93 & subsequently pt devel a ruptured disc, flu-like sx, h/a, gallbladder disease; weight dropped 39 pounds in 3 wks; pt was hospitalized; nurse felt that there was a problem w/the particular lot of vax;


VAERS ID: 62483 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Male  
Location: Kansas  
Vaccinated:1993-08-10
Onset:1993-09-01
   Days after vaccination:22
Submitted: 1994-05-03
   Days after onset:244
Entered: 1994-05-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1614V / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Aplastic anaemia, Haemorrhage intracranial, Hepatic failure, Hepatic necrosis, Hepatitis, Hepatomegaly, Leukopenia, Thrombocytopenia
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Cardiomyopathy (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-12-20
   Days after onset: 110
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: Hepatitis screening panel neg for A, B, & C; Anti-HBs pos, 323.4;
CDC Split Type: WAES94040553

Write-up: SEP93 c/o feeling of tired; NOV93 devel flu-like sx; 10DEC93 jaundice & vomiting & was hospitalized; devel acute liver failure of unknown cause & thrombocytopenia secondary to aplastic anemia; despite platelet transfusions, no improvement;


VAERS ID: 62491 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Maryland  
Vaccinated:1994-05-05
Onset:1994-05-06
   Days after vaccination:1
Submitted: 1994-05-09
   Days after onset:3
Entered: 1994-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366949 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0694H / 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: 1994-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: resolving gastrenteritis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD94014

Write-up: policeman called MD to tell that pt awoke @ 830AM was red put back to bed and found dead @ 1030AM;


VAERS ID: 62507 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-04-19
Entered: 1994-05-10
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 250915 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0591E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy was performed;
CDC Split Type: 940079801

Write-up: consumer reports that pt died in 1989 following DTP/OPV immun; autopsy was performed; no further details available;


VAERS ID: 62713 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Unknown  
Vaccinated:1994-04-27
Onset:1994-04-27
   Days after vaccination:0
Submitted: 1994-04-29
   Days after onset:2
Entered: 1994-05-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352914 / UNK - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1327A2 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 360960 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was brought to hosp by squad; DOA; pt apparently was healthy & put to bed by mom & found unresponsive @ approx 11PM & squad was called;


VAERS ID: 62784 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Mississippi  
Vaccinated:1994-04-04
Onset:0000-00-00
Submitted: 1994-04-22
Entered: 1994-05-16
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3051043 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150LL / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362949 / 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: 1994-04-10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: suspected sepsis
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS94022

Write-up: unk ; alleged to be SIDS;


VAERS ID: 62788 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1994-05-05
Onset:1994-05-06
   Days after vaccination:1
Submitted: 1994-05-13
   Days after onset:7
Entered: 1994-05-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 348982 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0857W / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cerebral ischaemia, Lung disorder, Sudden infant death syndrome
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: patient was a twin
Allergies:
Diagnostic Lab Data: Autopsy was performed;
CDC Split Type: NC94068

Write-up: death certificate: Cerebral Anoxia; Pulmonary Congestion; SIDS time of death 6:21 a.m.


VAERS ID: 63042 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Oregon  
Vaccinated:1994-04-05
Onset:1994-04-11
   Days after vaccination:6
Submitted: 1994-04-21
   Days after onset:10
Entered: 1994-05-23
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360916 / 3 - / L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1329B2 / 3 - / L

Administered by: Private       Purchased by: Private
Symptoms: Injection site pain, Sudden infant death syndrome
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: Albuterol
Current Illness: mild URI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type:

Write-up: minimal initial react, sl pain @ inject site only on day of immun confirmed SID''s 11APR94;


VAERS ID: 63044 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: New York  
Vaccinated:1994-05-03
Onset:1994-05-06
   Days after vaccination:3
Submitted: 1994-05-16
   Days after onset:10
Entered: 1994-05-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0178A / UNK GM / -

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Conjunctivitis, Dehydration, Encephalopathy, Otitis media, Pyrexia, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-07
   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: pvt
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-brain specimens sent for viral studies;
CDC Split Type:

Write-up: 2 days following inject pt devel OM & conjunctivitis w/fever; treated w/Augmentin; devel vomiting & dehydration 3 days p/vax; unexputed death autopsy showed brain edema;


VAERS ID: 63045 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:1994-04-27
Onset:1994-04-28
   Days after vaccination:1
Submitted: 1994-05-15
   Days after onset:17
Entered: 1994-05-23
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366947 / 1 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1317A2 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696L / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Somnolence, Sudden infant death syndrome
SMQs:, Anticholinergic syndrome (broad), Dementia (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: 1994-04-28
   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: APAP
Current Illness: NONE
Preexisting Conditions: reflux
Allergies:
Diagnostic Lab Data: 27APR94 checkup very healthy; 95% height & head; 75th% weight;
CDC Split Type:

Write-up: pt was given shots @ 3PM on 27APR94; pt slept from 830PM-530AM which was very unusual; pt recvd 1/2 dropper APAP immed p/vax;


VAERS ID: 63097 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1994-04-14
Onset:1994-04-15
   Days after vaccination:1
Submitted: 1994-05-09
   Days after onset:24
Entered: 1994-05-25
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3L41093 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0633W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M710KH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691C / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-15
   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: APAP
Current Illness: Resolving URI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy showed COD undetermined;
CDC Split Type: OH94048

Write-up: pt given 1st DTP/OPV/HIB 2nd Hep B on 14APR & was a little fussy that noc; pt put down for nap the following afternoon, found dead;


VAERS ID: 63110 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Mississippi  
Vaccinated:1994-05-12
Onset:1994-05-13
   Days after vaccination:1
Submitted: 1994-05-16
   Days after onset:3
Entered: 1994-05-26
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1414W / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS94024

Write-up: pt recvd vax & ER MD said pt had been down 30 mins a/arrival @ 418PM; dx SIDS; pt arrived @ hosp intubated & CPR in progress;


VAERS ID: 63124 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arizona  
Vaccinated:1994-04-07
Onset:1994-04-13
   Days after vaccination:6
Submitted: 1994-05-11
   Days after onset:28
Entered: 1994-05-27
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358918 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1101A4 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: bilateral culbbed feet; frade I/IV hrt M;
Allergies:
Diagnostic Lab Data: Autopsy-final report-SIDS;
CDC Split Type:

Write-up: On 13APR94 early AM parents found pt not breathing-attempted CPR-no response-rushed to ER by paramedics-no response to CPR in ER: pt pronounced dead; pt had not been ill;


VAERS ID: 63170 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Virginia  
Vaccinated:1994-03-15
Onset:1994-03-18
   Days after vaccination:3
Submitted: 1994-05-23
   Days after onset:65
Entered: 1994-05-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3D51083 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560KF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0698A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: 2 weeks p/bronchitis: doing well;
Preexisting Conditions: Prematurity, RDS; hospitalized for bronchitis 2 wks prior to vaxs being given;
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA94038

Write-up: Found dead in bed by paternal grandmother 18MAR94; CPR performed by EMT''s without success; autopsy performed: cause of death: disseminated viral infection (respiratory, renal, and gastrointestinal);


VAERS ID: 63217 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1994-04-11
Onset:0000-00-00
Submitted: 1994-05-19
Entered: 1994-06-02
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0301W / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150KC / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-11
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: MS94026

Write-up: pt died due to SIDS, pending autopsy 11MAY94;


VAERS ID: 63270 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:1994-05-09
Onset:1994-05-29
   Days after vaccination:20
Submitted: 1994-06-03
   Days after onset:5
Entered: 1994-06-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1153A2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-29
   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:

Write-up: unexplained death 29MAY94;


VAERS ID: 63297 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Wyoming  
Vaccinated:1994-01-17
Onset:1994-01-27
   Days after vaccination:10
Submitted: 1994-04-16
   Days after onset:78
Entered: 1994-06-07
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3A51135 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010KD / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362964 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Anorexia, Cough, Crying, Injection site reaction, Lung disorder, Otitis media, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-07
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP & Naldecon
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: initially had mild local react but 10 days later becme irritable, lost appetite & devel high pitched cry or cough; took ot ER MD made dx of lung congestion & bilateral ear infect;


VAERS ID: 63304 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Alabama  
Vaccinated:1993-05-04
Onset:1993-05-18
   Days after vaccination:14
Submitted: 1994-05-30
   Days after onset:377
Entered: 1994-06-08
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 326919 / 4 RA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0298W / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0678M / 3 - / -

Administered by: Private       Purchased by: Private
Symptoms: Infection, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: mild URI x 3d
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done 19MAY93; listed cause of death: disseminated viral infection;
CDC Split Type: AL9414

Write-up: pt died 18MAY93 p/2 day hx of vomiting & fever;


VAERS ID: 63305 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1994-05-20
Onset:1994-05-20
   Days after vaccination:0
Submitted: 1994-06-02
   Days after onset:13
Entered: 1994-06-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 566948 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1364A2 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 364978 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-24
   Days after onset: 4
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: EEG, CT, ETC done @ hosp;
CDC Split Type:

Write-up: pt recvd vax & mom put pt in crib on stomach came back & pt was blue & not breathing-taken to ER:


VAERS ID: 63321 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Montana  
Vaccinated:1991-06-17
Onset:1991-08-01
   Days after vaccination:45
Submitted: 1994-06-03
   Days after onset:1037
Entered: 1994-06-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arrhythmia, Cardiac arrest, Drug ineffective
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), 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), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-09-22
   Days after onset: 783
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: diabetes; Hemodialysis;
Allergies:
Diagnostic Lab Data: AUG91 Anti-HBs 0.9 neg;
CDC Split Type: WAES94011244

Write-up: pt recvd vax 17JUN91 & lab testing in AUG92 showed HBs antibody 0.9. pt died;


VAERS ID: 63322 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Montana  
Vaccinated:1992-05-20
Onset:1992-08-01
   Days after vaccination:73
Submitted: 1994-06-03
   Days after onset:671
Entered: 1994-06-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), 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), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-06
   Days after onset: 492
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: hemodialysis; Diabetes;
Allergies:
Diagnostic Lab Data: AUG92 Anti-HBs 0.7 neg;
CDC Split Type: WAES94020586

Write-up: pt recvd 3 doses of Hep B vax 13NOV91, 14DEC91 & 20MAY92 & lab testing in AUG92 showed HBs antibody 0.7; pt discontinued hemodialysis in DEC93 & died of renal failure on 06DEC93;


VAERS ID: 63459 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Iowa  
Vaccinated:1994-05-09
Onset:0000-00-00
Submitted: 1994-06-07
Entered: 1994-06-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51044 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M430KJ / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 364917 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st set immuns given 9MAY94; pt died of SIDS 12MAY94;


VAERS ID: 63460 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-06-07
Onset:1994-06-09
   Days after vaccination:2
Submitted: 1994-06-10
   Days after onset:1
Entered: 1994-06-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 370935 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Tagamet, Cisapride
Current Illness: None x/gastroesophageal reflux
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Autopsy by Coroner SIDS;
CDC Split Type:

Write-up: pt on monitor (discharged from hosp 28MAY p/nl pneumogram, mild GE reflux in PH probe, nl EEG p/poss apneic episode; pt found cyanotic 9JUN93 DOA in ER;


VAERS ID: 63736 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1994-05-20
Onset:1994-06-03
   Days after vaccination:14
Submitted: 1994-06-09
   Days after onset:6
Entered: 1994-06-20
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 370933 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: APAP
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN94078

Write-up: pt rcvd vax & became limp, pale, non responsive, lips were blue, eyes had a glassy stare; pt taken to ER & had tracheotomy and CPR was done; transfered to hospital & died at 9:02pm


VAERS ID: 63751 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: Maryland  
Vaccinated:1993-10-07
Onset:1994-04-17
   Days after vaccination:192
Submitted: 1994-06-16
   Days after onset:60
Entered: 1994-06-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0125W / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Infection, Meningitis, Pyrexia, Sepsis, Shock, Vascular occlusion
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 17APR94 Blood culture pos H. influenzae; CSF pos H. influenzae; 1994 Serology H. influenza type B & H. influenza type A (repeat test);
CDC Split Type: WAES94060397

Write-up: pt recvd vax & devel t105.6 & sz activity for over 30 mins; pt was treated w/diazepam; blood & CSF cultures were pos for H. influenzae; pt was transported to another facility & died during transport from septic shock & brainstem infarction


VAERS ID: 63766 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1994-05-25
Onset:1994-06-05
   Days after vaccination:11
Submitted: 1994-06-20
   Days after onset:15
Entered: 1994-06-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3E51112 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010KD / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366959 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Haemorrhage, Somnolence, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed-inconclusive poss SIDS;
CDC Split Type: CT9404

Write-up: 4JUN pt appeared to sleep longer than normal; 5JUN mom noticed blood on baby''s nose & found pt not breathing; ambulance was called pt was DOA @ hosp;


VAERS ID: 63823 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Virginia  
Vaccinated:1994-04-28
Onset:1994-04-29
   Days after vaccination:1
Submitted: 1994-05-09
   Days after onset:10
Entered: 1994-06-24
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 358915 / 2 GM / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0698W / 2 GM / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366960 / 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: 1994-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: full term
Allergies:
Diagnostic Lab Data: coroner''s report: sids
CDC Split Type: 940097301

Write-up: who-1:sudden infant death syndrome; after pt recvd vx, pt found dead in crib; pt had no visible local /systematic reaction; autopsy dx: sids; no reaction occured after 1st series of immunizations at 2mo;


VAERS ID: 63834 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Maryland  
Vaccinated:1994-06-06
Onset:1994-06-07
   Days after vaccination:1
Submitted: 1994-06-10
   Days after onset:3
Entered: 1994-06-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cyanosis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC Split Type: MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


VAERS ID: 63883 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Unknown  
Vaccinated:1971-10-12
Onset:1994-03-07
   Days after vaccination:8182
Submitted: 1994-05-24
   Days after onset:77
Entered: 1994-06-28
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PER: PERTUSSIS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Reporter claims pt died from pertussis vax; pt went through hell & never had a chance @ life;


VAERS ID: 63885 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Georgia  
Vaccinated:1994-06-01
Onset:1994-06-03
   Days after vaccination:2
Submitted: 1994-06-15
   Days after onset:12
Entered: 1994-06-28
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41111 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KP / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Condition aggravated, Infection, Laryngitis, Rash
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: ?had fever 2 days a/death
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94063

Write-up: mom reported to medical examiner that pt had fever (unk amt) the day a/immun & on the evening of 2JUN94 pt was found not breathing the morning of 3JUN; pt looked like had chicken pox;


VAERS ID: 63901 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1994-03-11
Onset:1994-03-25
   Days after vaccination:14
Submitted: 1994-05-03
   Days after onset:38
Entered: 1994-06-29
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352915 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0457W / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M015JL / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Infection, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94049

Write-up: SIDS


VAERS ID: 63928 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1994-05-25
Onset:1994-05-26
   Days after vaccination:1
Submitted: 1994-06-02
   Days after onset:7
Entered: 1994-06-30
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369906 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 705H / 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: 1994-05-26
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recvd vax 25MAy94 & pt found dead in bed 26MAY94; autopsy SIDS;


VAERS ID: 64423 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1994-06-01
Onset:1994-06-04
   Days after vaccination:3
Submitted: 1994-06-10
   Days after onset:6
Entered: 1994-07-05
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366947 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06961L / 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: 1994-06-04
   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: healthy;
Preexisting Conditions: no birth defect;chest X-ray 16may94;no definitive infiltrates; heart size normal; had pnemonia;bc growth for 7dys;
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type: 940122501

Write-up: pt rcvd vax; pt found dead in crib; tentative dx is sids;


VAERS ID: 64461 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1994-06-29
Onset:1994-06-30
   Days after vaccination:1
Submitted: 1994-06-30
   Days after onset:0
Entered: 1994-07-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372932 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1409W / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0700M / 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: 1994-06-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: amoxicillin;
Current Illness: bronchiolitis 9 dys earlier;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt rcvd vax; pt died of SIDS aprox 12 hrs after vax;


VAERS ID: 64462 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Iowa  
Vaccinated:1991-10-07
Onset:1991-10-11
   Days after vaccination:4
Submitted: 1994-06-20
   Days after onset:983
Entered: 1994-07-05
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Anorexia, Insomnia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: stuffy nose & rash;
Preexisting Conditions: hydrocele;
Allergies:
Diagnostic Lab Data: autopsy report - Dr
CDC Split Type:

Write-up: pt rcvd vax; pt did not sleep at all during eve of shots; seemed like pt was on drug & very wired; pt cried next day & would not eat; mom called RN; she said not to worry as long as pt not crying; pt did not eat & died in afternoon;


VAERS ID: 64497 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-03-21
Onset:1994-03-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1994-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1691W / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-24
   Days after onset: 61
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: high blood pressure;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & become seriously ill and died;


VAERS ID: 64595 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted: 1994-07-06
Entered: 1994-07-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2B41155 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120JJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346928 / 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: 1993-07-31
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: An autopsy was performed; Death certificate lists COD SIDS
CDC Split Type: MS94035

Write-up: parent did not report any vax react; however SIDS notification report was recvd by hlth dept on 27AUG93; subsequent visits were made 14SEP93 & 19OCT93 but no one would come to the door


VAERS ID: 64699 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Northern Mariana Islands  
Vaccinated:1994-04-25
Onset:1994-04-26
   Days after vaccination:1
Submitted: 1994-06-30
   Days after onset:65
Entered: 1994-07-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
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: 1994-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was seen by well baby clinic; no URI; pt was started on Amoxicillin; @ the same time vax for pt were administered; on AM 26APR94 pt was brought to ER unresponsive; CPR unsuccessful


VAERS ID: 64706 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Colorado  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-07-11
Entered: 1994-07-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: CSF test abnormal, Drug ineffective, Infection, Pain, Pyrexia, Respiratory disorder, Sepsis, Somnolence
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pcn;
Current Illness:
Preexisting Conditions: anemia; sickle cell
Allergies:
Diagnostic Lab Data: csf stain-gram pos. diploccoci; BC neg; culture CSF-neg;
CDC Split Type: WAES94060890

Write-up: pt recvd vax; pt was given pcn as prophylactic therapy; after discontinuation of pcn, pt devel fever including musculoskeletal pain, headache, diarrhea, respiratory symptoms & lethargy; staining of CSF showed gram-pos diploccoci; pt died;


VAERS ID: 64713 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1994-03-01
Onset:1994-03-01
   Days after vaccination:0
Submitted: 1994-03-07
   Days after onset:6
Entered: 1994-07-14
   Days after submission:128
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 4 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366959 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-02
   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: Dilantin
Current Illness: NONE
Preexisting Conditions: sz disorder controlled w/Dilantin (immun ok''d by MD)
Allergies:
Diagnostic Lab Data: Autopsy-findings consistent w/sz disorder;
CDC Split Type: KY940007

Write-up:


VAERS ID: 64720 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Kentucky  
Vaccinated:1993-11-11
Onset:1993-11-12
   Days after vaccination:1
Submitted: 1994-04-19
   Days after onset:157
Entered: 1994-07-14
   Days after submission:86
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1045V / 2 LL / IM

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: 1993-11-12
   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: NONE
Allergies:
Diagnostic Lab Data: autopsy done;
CDC Split Type: KY940014

Write-up: Pt recvd vax 11NOV94 & sids death 12NOV93;


VAERS ID: 64726 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Kentucky  
Vaccinated:1994-04-11
Onset:1994-04-20
   Days after vaccination:9
Submitted: 1994-04-25
   Days after onset:5
Entered: 1994-07-14
   Days after submission:80
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366946 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1787W / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0697F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY940020

Write-up: SIDS


VAERS ID: 64731 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Kentucky  
Vaccinated:1994-05-04
Onset:1994-05-20
   Days after vaccination:16
Submitted: 1994-06-17
   Days after onset:28
Entered: 1994-07-14
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366946 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0701A / 3 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: 1994-05-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: autopsy sids;
CDC Split Type: KY940025

Write-up: pt recvd vax; pt died of SIDS w/in 30 days of vax;


VAERS ID: 64748 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Wisconsin  
Vaccinated:1994-06-16
Onset:1994-06-16
   Days after vaccination:0
Submitted: 1994-07-12
   Days after onset:26
Entered: 1994-07-15
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3E51125 / 4 - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51126 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0697F / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5460

Write-up: pt recvd vax; pt expired 10 hrs after vax; coroner still running test to find cause of death;


VAERS ID: 64750 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-07-13
Entered: 1994-07-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Pneumonia, Sepsis
SMQs:, Lack of efficacy/effect (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-05-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: desferal; steroid, nos;
Current Illness:
Preexisting Conditions: lymphoma, lymphocytic; hepatitis, granulomatous;
Allergies:
Diagnostic Lab Data: BC pneumococcal type 6B;
CDC Split Type: WAES94060925

Write-up: pt recvd vax; pt died from pneumonia w/ bacteremia; BC revealed pneumococcal serotype 6B;


VAERS ID: 64763 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:1994-06-09
Onset:1994-06-13
   Days after vaccination:4
Submitted: 1994-07-13
   Days after onset:30
Entered: 1994-07-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Nuchal rigidity, Respiratory disorder, Thrombocytopenia
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-20
   Days after onset: 7
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: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC Split Type: WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


VAERS ID: 64764 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: American Samoa  
Vaccinated:1994-03-03
Onset:1994-03-09
   Days after vaccination:6
Submitted: 1994-05-27
   Days after onset:78
Entered: 1994-07-15
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51025 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M170KB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0698A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: CSF test abnormal, Cerebral infarction, Dermatitis bullous, Encephalitis, Intracranial pressure increased, Nuchal rigidity, Pyrexia, Sepsis
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (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, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: BC - staph coagulase pos; spinal fluid cuture - pos . strep pneumonia ;
CDC Split Type: AS941

Write-up: pt recvd vax; 6 days after vax pt devel t 104, building fontanels, stiff neck, lg peeling blisters on buttocks; periods of irritability & sleepiness; dx - strep pneumococial, meningoencepalitis, ventromegaly multi cerebral infacts;


VAERS ID: 64808 (history)  
Form: Version 1.0  
Age: 35.0  
Sex: Male  
Location: Ohio  
Vaccinated:1994-05-17
Onset:1994-05-18
   Days after vaccination:1
Submitted: 1994-07-05
   Days after onset:48
Entered: 1994-07-19
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 348909 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Arrhythmia, Arteriosclerosis, Coronary artery occlusion, Nausea, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: acute cardiac dyrrithynia due to coronary arthrosclerosis w/80% occulsion Lt & rt coronary arteries
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type: OH94064

Write-up: pt recvd vax & had n & v; wife found pt unresponsive & not breathing;


VAERS ID: 64863 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1994-06-27
Onset:1994-06-27
   Days after vaccination:0
Submitted: 1994-07-05
   Days after onset:8
Entered: 1994-07-22
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0417W / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010KD / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Apnoea, Hypotonia, Pallor, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-06-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & went home midly fussy & 4 to 6 hrs later p/feeding & being laid supine was found limp/pale/apnic; irritable, cry, pale, unresponsive, not breathing


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