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VAERS ID: 64879 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-07-19
Entered: 1994-07-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Coma, Convulsion, Drug ineffective, Hypotension, Infection, Leukopenia, Sepsis, Tachycardia
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: vitamin k; pcn;
Current Illness: leukemia,lymphoblastic;septicemia staphy
Preexisting Conditions: splenectomy; thrombectomy; leukemia, lymphoblastic;
Allergies:
Diagnostic Lab Data: glucose non defect;WBC count 2600; granulocytes 63%; platelet count 250000; hemoglobin 12.8 g/dl; BC pneumococcus serotype 6;
CDC Split Type: WAES94061268

Write-up: pt recvd vax & f & rt thrombus was identified;lab revealed deficient protein c;pt devel f related to rhinopharyngitis & found in stuporous state w/ convuls;was in coma w/ opisthotonus,t 39 c,HR 175,BP 29mm hg, BC pneumococcus serotype 6;


VAERS ID: 64905 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Kansas  
Vaccinated:1994-07-19
Onset:1994-07-19
   Days after vaccination:0
Submitted: 1994-07-19
   Days after onset:0
Entered: 1994-07-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 377917 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691M / UNK - / -

Administered by: Military       Purchased by: Military
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: 1994-07-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & was unresponsive; ems was activated & recucitation initiated; pt taken to hosp & died;


VAERS ID: 65077 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Kentucky  
Vaccinated:1994-05-12
Onset:1994-05-15
   Days after vaccination:3
Submitted: 1994-07-12
   Days after onset:58
Entered: 1994-07-27
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369907 / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362964 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 12JUL94 & 15MAY parent found the pt cyanotic, & not breathing; impression noted as SIDS (SIDS);


VAERS ID: 65078 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Kentucky  
Vaccinated:1994-07-06
Onset:1994-07-07
   Days after vaccination:1
Submitted: 1994-07-12
   Days after onset:5
Entered: 1994-07-27
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369906 / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362953 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-07-07
   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:
Current Illness:
Preexisting Conditions: pt although only 2 mos old was s/p surgical diaphragmatic hernia repair; ther was also noted a/v septal defect; ASVD; prior tx in this facility for episodes of cessation of breathing
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & 6JUL94 w/in 24 hrs 7JUL pt expired; pt has neg for sz disorder, CP, prior react to DTP & other immun, steroid therapy, immune deficiency disorder & exposure to chicken pox;


VAERS ID: 65691 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: Montana  
Vaccinated:1987-11-28
Onset:0000-00-00
Submitted: 1994-07-26
Entered: 1994-08-01
   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: Abscess
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hemodialysis
Allergies:
Diagnostic Lab Data: FEB88 Anti-HBs 31.2 pos
CDC Split Type: WAES94050830

Write-up: pt recvd vax & did not seroconvert; 11 of 16 dialysis pts were vaxed w/Hep B vax & were anti-HBs neg approx 3 months p/series; f/u lab testing in FEB88 showed HBs antibody 31.2; pt devel ruptured diverticular abscess of large bowel & died;


VAERS ID: 65692 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Montana  
Vaccinated:1992-05-03
Onset:0000-00-00
Submitted: 1994-07-26
Entered: 1994-08-01
   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: Vascular anomaly
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-07-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: JUL92 Anti-HBs 146.9 pos
CDC Split Type: WAES94050829

Write-up: Pt recvd vax & did not seroconvert; 11 of 16 dialysis pts were vaxed w/Hep B vax & were anti-HBs neg approx 3 months p/series; on f/u lab testing in JUL92 showed HBs antibody 146.9; pt devel ruptured abdo aneurysm & died on 2JUL93;


VAERS ID: 65748 (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: 1994-07-29
   Days after onset:52
Entered: 1994-08-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


VAERS ID: 65760 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:1994-07-13
Onset:1994-07-18
   Days after vaccination:5
Submitted: 1994-08-01
   Days after onset:14
Entered: 1994-08-03
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1232W / 2 RA / -
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. J0661 / 3 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Haemolytic anaemia, Immune system disorder, Marrow hyperplasia, Pericardial effusion, Thrombocytopenia, Vasculitis
SMQs:, Haemolytic disorders (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Arthritis (broad), Myelodysplastic syndrome (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: 1994-08-01
   Days after onset: 14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT Scan, bone marrow test
CDC Split Type: TX94176

Write-up: autoimmunhemolytic anemia & thrombocytopenia secondary to serum sickness; pt adm to hosp following severe multiple vomiting episodes; 18JUL94 reported itching on back of neck; 22JUL94 pt exp rash; 26JUL94 exp severe multiple vomiting;


VAERS ID: 65907 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Utah  
Vaccinated:1994-04-09
Onset:1994-06-25
   Days after vaccination:77
Submitted: 1994-08-04
   Days after onset:40
Entered: 1994-08-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 366948 / 3 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 699F2 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Infection, Influenza, Meningitis, Pneumonia, Poliomyelitis, White blood cell disorder
SMQs:, Haematopoietic leukopenia (broad), Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes, 23 days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bare lymphocyte synd; polio type II virus isolated from stool;
CDC Split Type: UT941818

Write-up: fever & cold-like sx began 25JUN94 pt was given Septra sx did not improve; MD visit 5JUl94 & dx w/pneumonia, ear infections & flu; mom reported child''s lt arm limp 8JUL94; on 9JUL94 visted hosp ER; spinal tap revealed meningitis;


VAERS ID: 65959 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Female  
Location: Georgia  
Vaccinated:1994-06-01
Onset:0000-00-00
Submitted: 1994-06-06
Entered: 1994-08-19
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41111 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130KE / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696M / 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: 1994-06-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94077

Write-up: SIDs


VAERS ID: 65994 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Texas  
Vaccinated:1994-06-13
Onset:1994-06-14
   Days after vaccination:1
Submitted: 1994-07-18
   Days after onset:34
Entered: 1994-08-19
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372933 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0698F / 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: 1994-06-14
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX94183

Write-up: pt died @ approx 3AM 14JUN94 coroners report COD-SIDS recvd DTP/HIB & OPV on 13JUN94;


VAERS ID: 65999 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1994-06-29
Onset:1994-08-02
   Days after vaccination:34
Submitted: 1994-08-08
   Days after onset:6
Entered: 1994-08-19
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 374964 / 1 - / L
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1099W / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 368979 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Cardiac failure, Pyrexia, Rhinitis, Stupor
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 24JUN-vomiting
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX94188

Write-up: pt was fine @ 6PM 2AUG94; 10AM pt was unresponsive, taken to hosp, pt died 2AUG94; fever 102.9, runny nose autopsy was inconclusive -coronary failure pending further investigation;


VAERS ID: 66001 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1993-03-09
Onset:1993-03-22
   Days after vaccination:13
Submitted: 1994-08-13
   Days after onset:508
Entered: 1994-08-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1186V / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0658L12 / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Dehydration, Hepatocellular damage, Infection, Jaundice, Lymphocytosis, Pyrexia, Spleen disorder
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-06-11
   Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 60 days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergic to sulfa other than that healthy
Allergies:
Diagnostic Lab Data: MD felt pt had hepatitis, but test came back neg, it was determined pt had mono from EBV
CDC Split Type:

Write-up: fever, vomiting, dehydration, jaundice, tired, blood problems, liver & spleen problems went on for over 2 months;


VAERS ID: 66141 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-06-08
Onset:1994-06-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1994-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369908 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699M / 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: 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: Lotrisone cream for diaper rash
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy-SIDS
CDC Split Type:

Write-up: autopsy dx: COD-consistnet w/SIDS


VAERS ID: 66282 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1994-05-25
Onset:1994-05-27
   Days after vaccination:2
Submitted: 1994-07-05
   Days after onset:39
Entered: 1994-09-02
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4K1059 / 3 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0989W / 2 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / 3 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06920 / 3 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: 1994-05-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp fever w/immun nothing else;~ ()~~~In Sibling
Other Medications: Vi-daylin/F
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA94099

Write-up: more crying than usual on Thursday when put down; Sudden infant death synd


VAERS ID: 66285 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1993-12-07
Onset:1993-12-17
   Days after vaccination:10
Submitted: 1994-07-14
   Days after onset:208
Entered: 1994-09-02
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 356911 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0989W / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010KD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0692D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA94102

Write-up: poss SIDS death; immun given 17DEC93; mom reports pt had no react to immun;


VAERS ID: 66311 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Iowa  
Vaccinated:1994-07-01
Onset:0000-00-00
Submitted: 1994-08-31
Entered: 1994-09-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51051 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0942W / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51079 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 368950 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: LGA-tachypnea @ birth-poss sepsis-trtw/rx; 27MAY94 OM
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: NONE


VAERS ID: 66349 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New York  
Vaccinated:1994-02-02
Onset:1994-02-02
   Days after vaccination:0
Submitted: 1993-09-09
   Days after onset:146
Entered: 1994-09-08
   Days after submission:364
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Anorexia, Bronchitis, Pharyngitis, Pneumonia, Rhinitis, Screaming
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt recvd Tetramune & Hep B vax & OPV on 2MAR94;
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt cried for 7 days day & noc, nearly nonstop; pt refused to take breast & bottle; unable to comfort pt; pt did not eat or drink; pt devel a bad cold-bronchitis-pneumonia;


VAERS ID: 76686 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1986-06-03
Onset:1986-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: 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: 1986-06-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: "marked" cranial asymetry OFC at 2 mo 90% (41cm) jitery, fussy, irritable, inconsolable at birth x 2 days; positive meconium; maternal smoking
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death; (fever prior to death)


VAERS ID: 76687 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Minnesota  
Vaccinated:1991-07-24
Onset:1991-08-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-03
   Days after onset: 733
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, rash , red throat;


VAERS ID: 76688 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1980-10-23
Onset:1980-10-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1980-11-05
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had been well;found unresponsive w/o spontaneous resp in crib,approx an hr p/ being fed; dx SIDS; no autopsy performed;


VAERS ID: 76689 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1977-10-24
Onset:1977-10-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1977-10-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: nl growth devel & exam; med records; recvd DTP & OPV 28sep77 allegedly he recvd DTP & OPV on 26oct77;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: on 26oct77,pt was found unresponsive w/ cardiopulmonary arrest;resuscitation in er was ineffective;autopsy was unremarkable,COD was SIDS;


VAERS ID: 76690 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1979-02-05
Onset:1979-02-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1979-02-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none hyperbilirubinemia of newborn;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found dead in bed hrs p/ DTP;


VAERS ID: 76691 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1987-10-14
Onset:1987-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1987-10-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found dead w/in 48 hrs following adm of 1st dtp;autopsy findings consistent w/ SIDS;


VAERS ID: 76692 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Nevada  
Vaccinated:1988-02-29
Onset:1988-03-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1988-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none found dead in crib 3rd day post dtp;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: none, death;


VAERS ID: 76693 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Alabama  
Vaccinated:1973-02-07
Onset:1973-02-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1973-02-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity - 35-36 wks of gestation none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS;


VAERS ID: 76694 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arizona  
Vaccinated:1982-12-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1982-12-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none maternal smoking; prone position in water bed;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: none; found dead;


VAERS ID: 76695 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1982-11-17
Onset:1982-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1982-11-23
   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:
Current Illness:
Preexisting Conditions: none maternal hx - previous gestation, still birth
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS; found dead;


VAERS ID: 76697 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1986-03-05
Onset:1986-03-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypothermia, Mydriasis, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Accidents and injuries (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1986-03-07
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none 5mar86 at age 5 mo, had hx of a URI; colic & a diaper rash;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7mar86 pt found asystole by babysitter & EMT ,no resp effort,cyanosis,dilated fixed pupils,resp effort & cool skin/T;failed to respond to CPR;autopsy including brain microscopy revealed only pulmonary congestion; death due to SIDS;


VAERS ID: 76698 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Colorado  
Vaccinated:1988-07-01
Onset:1988-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 187663 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1988-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none infant found dead in crib morning p/ vax, no prodome;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: crib death;


VAERS ID: 76699 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1988-08-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 7D91037 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1988-08-29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death;


VAERS ID: 76700 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Iowa  
Vaccinated:1987-10-08
Onset:1987-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: 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 (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1987-10-14
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none known; transcient tachypnea at birth;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14oct87 pt was apparently well;found under crib a few hrs later w/ cardiopulmonary arrest;autopsy including brain revealed no significant findings;COD attributed to SIDS;


VAERS ID: 76701 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Louisiana  
Vaccinated:1989-02-13
Onset:1989-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 208939 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none put to bed for mid-am nap; found dead;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dead; autopsy unrevealing;


VAERS ID: 76703 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Louisiana  
Vaccinated:1993-04-22
Onset:1993-04-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH M120JJ / UNK - / -

Administered by: Public       Purchased by: Unknown
Symptoms: 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 (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: premature AGA female infant (34 wks);pos hx of ETDH and social problems during pregnancy;little prenatal care;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found unresponsive in crib; no hx by er MD of problems preceeding arrest;


VAERS ID: 76704 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1975-05-13
Onset:1975-05-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1975-05-13
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: virtually no record for review; it appears to have been unexplained crib death same day as dtp; SIDS death;


VAERS ID: 76705 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: North Carolina  
Vaccinated:1976-10-05
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1976-10-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none 4oct76 mom had shingles (herpes zoster) of the rt shoulder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7oct76 appeared nl & had no recent illness;fed & was placed in crib;2 hrs later,found dead;autopsy revealed no significant abnormalities;probable COD was SIDS;


VAERS ID: 66741 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1994-08-29
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1994-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G501020 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1547W / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460LA / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0689A / 1 MO / PO

Administered by: Private       Purchased by: Unknown
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: 1994-08-30
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: Autopsy-consistent w/sids;
CDC Split Type: NH94021

Write-up: irritable for several hrs later that day; next morning pt was fine, smiling, acted nl w/good eating, etc; then put down for a nap & 15-20 mins later-no response;


VAERS ID: 66767 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-09-12
Onset:1994-09-13
   Days after vaccination:1
Submitted: 1994-09-14
   Days after onset:1
Entered: 1994-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51043 / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-13
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5548

Write-up: died; found non-responsive in crib by mom; rescue squad not able to resusitate; No other info available @ this time;


VAERS ID: 66768 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Alabama  
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted: 1994-08-05
Entered: 1994-09-19
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Azotaemia, Brain oedema, Clostridium colitis, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia
SMQs:, Acute renal failure (narrow), Haemolytic disorders (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Pseudomembranous colitis (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-08-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC Split Type: AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


VAERS ID: 66939 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-08-29
Onset:1994-09-06
   Days after vaccination:8
Submitted: 1994-09-13
   Days after onset:7
Entered: 1994-09-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380999 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 368955 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-06
   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: full-term; no allergies;
Allergies:
Diagnostic Lab Data: chest x-ray - cardiac arrest; autopsy performed - results pending;
CDC Split Type: 940190901

Write-up: pt recvd vac & found dead at home; found in crib face-down with head resting on a large pillow;


VAERS ID: 66940 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:1994-08-09
Submitted: 1994-09-13
   Days after onset:35
Entered: 1994-09-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unknown;
Current Illness:
Preexisting Conditions: pt was not under care of reporting md; it is uncertain if infant was immunized at a pub hlth clinic or pvt md;
Allergies:
Diagnostic Lab Data: autopsy performed - results pending;
CDC Split Type: 940190902

Write-up: pt recvd vax & found dead in crib; autopsy pending, tentative dx: sids; pt was not a well baby; hospitalized shortly after birth;


VAERS ID: 66962 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Kansas  
Vaccinated:1994-03-11
Onset:0000-00-00
Submitted: 1994-09-23
Entered: 1994-09-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360916 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 358937 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 66999 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-09-29
Entered: 1994-10-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: oxygen;
Current Illness:
Preexisting Conditions: chronic lung disease;
Allergies:
Diagnostic Lab Data: titer 0.43 mcg/ml after 1st dose; titer 0.73 mcg/ml after 2nd dose;
CDC Split Type: WAES94090993

Write-up: Study conducted to determine Ab response to PEDVAXHIB in 30 consecutive premature infants who required supplemental oxygen because of chronic lung disease; 6 failed to complete study & 2 died; chronically ill infants do not respond as well;


VAERS ID: 67000 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-09-29
Entered: 1994-10-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: oxygen;
Current Illness:
Preexisting Conditions: chronic lung disease;
Allergies:
Diagnostic Lab Data: titer .43 mcg/ml after 1 dose, .73 mcg/ml after 2 dose;
CDC Split Type: WAES94090398

Write-up: Study conducted to determine Ab response to PEDVAXHIB in 30 consecutive premature infants who required supplemental O2 because of chronic lung disease; 6 failed to complete study, 2 died; chronically ill premature infants don''t respond as..


VAERS ID: 67107 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Colorado  
Vaccinated:1994-09-20
Onset:1994-09-21
   Days after vaccination:1
Submitted: 1994-10-03
   Days after onset:12
Entered: 1994-10-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51146 / UNK LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1392B2 / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61024 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cerebral infarction, Coma, Inappropriate antidiuretic hormone secretion, Infection, Meningitis, Respiratory disorder, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hyponatraemia/SIADH (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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: 1994-09-30
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF: gram+ diplococci, 24 WBCs; 25SEP94 CT scan: multiple samll infarcts in brain & brainstem;
CDC Split Type: CO5560

Write-up: vomit, bruise on leg, seen in ofc; 22SEP94 adm; obtunded, stiff neck, septic shock; preliminary dx meningitis; probable strep; 25SEP94 small infarcts in brain & brainstem, comatose; 27SEP94 extubated; 28SEP94 SIANH; died 10:30AM 30SEP94;


VAERS ID: 67270 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1994-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: infant, 4 mos died 24 hrs after vax in ofc 25 yrs ago; was critically ill in 1 hr;


VAERS ID: 67348 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Unknown  
Vaccinated:1994-10-03
Onset:1994-10-04
   Days after vaccination:1
Submitted: 1994-10-11
   Days after onset:7
Entered: 1994-10-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352915 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380938 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness:
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: gross post mortem exam reveals no cause of death;
CDC Split Type:

Write-up: pt recvd vax & died; per TARS: child awoke at 6:00AM, did not follow usual habit but appeared well then several abnormal cries, child then appeared in extremis;


VAERS ID: 67351 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Texas  
Vaccinated:1994-09-19
Onset:1994-09-19
   Days after vaccination:0
Submitted: 1994-10-03
   Days after onset:14
Entered: 1994-10-17
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372934 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0701L / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Dyspnoea, Hyperkalaemia, Hyperventilation, Hypotension, Pyrexia, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: chest bone depressed during breathing;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & had respiratory dis;dx w/ hyperkalemia; sepsis;slight depression on breathing;fussy;gagging;had heaves; difficulty in breathing; was pale;cyanosis;weak pulse & unobtainable BP;grunting in acute respiratory distress;1 100.7;v


VAERS ID: 67353 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Illinois  
Vaccinated:1994-04-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1994-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 356913 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 364973 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Somnolence, Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: post mortem results unknown;
CDC Split Type:

Write-up: pt recvd vax & became fussy; would not sleep on back; pt found in bed w/ vomitus around mouth;


VAERS ID: 67397 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Georgia  
Vaccinated:1994-04-13
Onset:1994-04-22
   Days after vaccination:9
Submitted: 1994-08-26
   Days after onset:126
Entered: 1994-10-18
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 350919 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1484W / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M10KA / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0694E / 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: 1994-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94143

Write-up: pt recvd vax was found dead w/ face against mattress & head against foot board; died of asphyxia;


VAERS ID: 67418 (history)  
Form: Version 1.0  
Age: 48.0  
Sex: Female  
Location: Nevada  
Vaccinated:1994-09-30
Onset:1994-10-01
   Days after vaccination:1
Submitted: 1994-10-18
   Days after onset:17
Entered: 1994-10-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0445A / 1 - / IM

Administered by: Public       Purchased by: Private
Symptoms: Arteriosclerosis, Chest pain, Cholecystitis, Cholelithiasis, Condition aggravated, Dyspepsia
SMQs:, Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-10-02
   Days after onset: 1
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness:
Preexisting Conditions: atherosclerosis, cholelithiasis; medical hx: hysterectomy, appendectomy;
Allergies:
Diagnostic Lab Data: none;
CDC Split Type: WAES94100074

Write-up: pt recvd vax 20oct94 & exp chest pain & was hosp; pt died same day;


VAERS ID: 67428 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Massachusetts  
Vaccinated:1994-10-03
Onset:1994-10-04
   Days after vaccination:1
Submitted: 1994-10-11
   Days after onset:7
Entered: 1994-10-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP290 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 3 RL / -

Administered by: Private       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? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-10-05
   Days after onset: 1
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: clear runny nose;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & following morning pt ate, played & took a nap then father checked & found not breathing; cpr performed; initially resusitated at hosp then transferred;


VAERS ID: 67562 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Iowa  
Vaccinated:1994-09-30
Onset:1994-10-02
   Days after vaccination:2
Submitted: 1994-10-18
   Days after onset:16
Entered: 1994-10-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0830A / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cerebral haemorrhage, Coagulopathy, Convulsion, Haemorrhage, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: nl platelets ct; no purpura;
CDC Split Type:

Write-up: pt recvd vax at checkup; onset of vomiting 2 days after vax; v sporadic, then freq til onset of focal sz 2 days later; ct scan showed cerebral hemorrhage; analysis showed DIC-like picture; cont cns bleeding, eventual death; no post mortem;


VAERS ID: 67764 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1994-10-18
Onset:1994-10-20
   Days after vaccination:2
Submitted: 1994-10-20
   Days after onset:0
Entered: 1994-10-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1223ASB / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0695E / 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: 1994-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Not ill
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: coroner came & picked up child @ home;
CDC Split Type:

Write-up: 20OCT94 father woke up @ 830AM & found deceased; immed prior to event, pt had no apparent signs of sx;


VAERS ID: 67798 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-10-28
Entered: 1994-10-31
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MU: MUMPS (MUMPSVAX I) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Encephalitis, Influenza, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1968-06-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES94100678

Write-up: 4 month old child received vax; one month p/vax, developed a cold & flu-like sxs; was treated w/penicillin & sxs got worse; on 12JUN68 pt died due to encephalitis;


VAERS ID: 67845 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1994-09-15
Onset:1994-10-11
   Days after vaccination:26
Submitted: 1994-10-26
   Days after onset:15
Entered: 1994-10-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380969 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703F / 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: 1994-10-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy done;
CDC Split Type:

Write-up: pt died of SIDS on 11OCT94 MD stated;


VAERS ID: 67959 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:1994-10-18
Onset:1994-10-19
   Days after vaccination:1
Submitted: 1994-10-31
   Days after onset:12
Entered: 1994-11-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51155 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arteriosclerosis, Cardiomegaly, Hepatomegaly, Pulmonary embolism
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5625

Write-up: died; only has rumored info, no details about incidence;


VAERS ID: 68044 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:1983-05-31
Submitted: 1994-10-28
   Days after onset:4168
Entered: 1994-11-07
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB - / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Apnoea, Crying, Gaze palsy, Opisthotonus, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1983-05-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; at time of injection her back arched; eyes rolled back & mouth opened but no sound came out; pt then began to cry w/in 10 min was calm; 2 hrs later appear lathagic then went into high pitch screaming; stopped breathing & died;


VAERS ID: 68050 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1994-10-04
Onset:1994-10-20
   Days after vaccination:16
Submitted: 1994-10-26
   Days after onset:6
Entered: 1994-11-07
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948100 / 4 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Arteriosclerosis, Cardiac arrest, Chest pain, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-26
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: valium;
Current Illness: none;
Preexisting Conditions: nka anxiety, nervousness;
Allergies:
Diagnostic Lab Data: cardiac work up;
CDC Split Type:

Write-up: pt recvd vax; 20oct94 seen in ER for chest pain; started 7AM after eating; walked 10 blocks to hosp; admit 22oct94 expired;


VAERS ID: 68153 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Unknown  
Location: New Hampshire  
Vaccinated:1994-10-10
Onset:1994-10-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1994-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51113 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Asthenia, Cough, Pneumonia, Pyrexia, Thirst
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-05
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin, Furosemide, Capoten;
Current Illness:
Preexisting Conditions: IDDM, HTN, obesity
Allergies:
Diagnostic Lab Data: K 3.3;
CDC Split Type: NH94033

Write-up: 2 wks p/vax pt became weak, tired, anorexic, devel fever, cough, pneumonia; progressing to death;


VAERS ID: 68154 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-10-14
Onset:1994-10-16
   Days after vaccination:2
Submitted: 1994-11-08
   Days after onset:23
Entered: 1994-11-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51113 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Dehydration, Myasthenic syndrome, Pneumonia, Right ventricular failure
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Malignancy related conditions (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-04
   Days after onset: 19
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: s/p CVA many yrs ago
Preexisting Conditions: s/p CVA many yrs ago;
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94034

Write-up: 2d p/vax pt became anorexic, thirsty, devel lt leg weakness; became dehydrated, was hospitalized & went into CHF- ? pneumonia;


VAERS ID: 68357 (history)  
Form: Version 1.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:1994-10-24
Onset:1994-10-28
   Days after vaccination:4
Submitted: 1994-11-04
   Days after onset:7
Entered: 1994-11-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK - / IM

Administered by: Public       Purchased by: Private
Symptoms: Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood lactate dehydrogenase increased, Condition aggravated, Hyperbilirubinaemia, Leukocytosis, Pyrexia
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: prednisone; danazol; flagyl, cipro, hemaspan, diflucan, prilosec, carafate, procrit, micronase, K-dur, coumadin, maxzide, trilisate, xanax, restoril;
Current Illness: chronic liver & gi tract inflammation
Preexisting Conditions: cryptogenic cirrhosis, ulcerative colitis, portal vein thrombosis, autoimmune phenomena, haemolytic anaemia;
Allergies:
Diagnostic Lab Data: 24oct94 WBC 17.2, RBC 4.54, HGB 15.6; HCT 44.5, platelets 464, sgot 160, alk phos 199, bili 16.9, ldh 562, bun 14, creat 0.9, 28oct94 wbc 24.9, rbc 3.17, hgb 11.2, hct 31.4, platelets 366;
CDC Split Type: ALI94235

Write-up: pt recvd vax;4 days after vax w/ fluvirin pt at MD ofc w/ fever of 101; blood tests revealed worsening of pre-existing haemolytic anaemia & pt hosp 28oct94;pt potential candidate for liver transplant;MD said pt condition not related to vax;


VAERS ID: 68363 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Alabama  
Vaccinated:1994-10-18
Onset:1994-10-20
   Days after vaccination:2
Submitted: 1994-11-05
   Days after onset:16
Entered: 1994-11-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380999 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: tagamet / reglan;
Current Illness: GE reflux;
Preexisting Conditions: failure to thrive; GE reflux;
Allergies:
Diagnostic Lab Data: none;
CDC Split Type:

Write-up: pt recvd vax; found in crib approx 5am not breathing; PAR took to med ctr; MD determined that pt was in full arrest; pt died at hosp;


VAERS ID: 68382 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: New York  
Vaccinated:1994-10-17
Onset:1994-10-19
   Days after vaccination:2
Submitted: 1994-10-25
   Days after onset:6
Entered: 1994-11-14
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Asthenia, Condition aggravated, Dyspnoea, Lung disorder, Malaise, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-19
   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: many meds (unspecified); prednisone;
Current Illness: severe chest pain the day a/flu shot;
Preexisting Conditions: severe chronic osteoarthritis; respiratory problems; recurrent pulmonary infections; intermittent angina w/frequent exacerbations of CHF; Parkinsons disease; HCVD; chronic bronchitis w/recurrent asthma; ASHD w/angina;
Allergies:
Diagnostic Lab Data: not provided;
CDC Split Type: 32777

Write-up: pt recvd single dose of flu vax as a prophylaxis 17oct94; pt died 19oct94; cause of death unk; pt was recving many other meds;


VAERS ID: 68383 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: New York  
Vaccinated:1994-10-17
Onset:1994-10-17
   Days after vaccination:0
Submitted: 1994-10-25
   Days after onset:8
Entered: 1994-11-14
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many meds(unspecified); antidepressant;
Current Illness: edema; severe obtundation; hypotensive;
Preexisting Conditions: osteoarthritis, back & knees; arthritis large axial joints; bladder incontinent; hx of rt mastectomy 10-12 yrs ago for breast carcinoma; chronic bacteriuria; fibromyalgia; erratic appetite; depression; degenerative heart disease;
Allergies:
Diagnostic Lab Data: not provided;
CDC Split Type: 32778

Write-up: pt recvd single dose of vax on 17oct94 as a prophylaxis; pt died 20oct94; cause of death unk; pt was receiving many oth meds;


VAERS ID: 68384 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:1994-10-17
Onset:1994-10-21
   Days after vaccination:4
Submitted: 1994-10-24
   Days after onset:3
Entered: 1994-11-14
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Condition aggravated, Lung disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many meds (unspecified);
Current Illness:
Preexisting Conditions: alcohol abuse -$g progressive neuropathy, uncertain etiology; hypertension; atrial fibrillation; macular degeneration; constipation; recurrent UTI''s; hx of left ovarian cyst; COPD; rt hip fracture, intertrochanteric, s/p internal fixation;
Allergies:
Diagnostic Lab Data: not provided;
CDC Split Type: 32779

Write-up: pt recvd single dose of flu vax as a prophylaxis 17oct94; pt died 21oct94; cause of death unk; pt was receiving many oth meds;


VAERS ID: 68391 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1994-02-10
Onset:1994-02-28
   Days after vaccination:18
Submitted: 1994-11-03
   Days after onset:248
Entered: 1994-11-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41116 / 1 RA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1045W / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005JP / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0680K / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL94088

Write-up: pt recvd vax; mom reported that pt felt feverish on 28feb94 am; no t taken; mom also reported infant had difficulty breathing; infant arrested approx 11:30-12pm; cpr attempted but pt pronounced dead; autopsy & cause of death SIDS;


VAERS ID: 68425 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Virginia  
Vaccinated:1994-09-14
Onset:1994-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 360917 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707H / 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: 1994-09-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: apap;
Current Illness: neck rash;
Preexisting Conditions: gastroesophageal reflux; preterm 4-3;
Allergies:
Diagnostic Lab Data: none;
CDC Split Type:

Write-up: pt recvd vax; recvd WB exam 14sep94; mom found baby dead in early am; cold slept on stomack in play pen;


VAERS ID: 68427 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Iowa  
Vaccinated:1994-10-27
Onset:1994-10-28
   Days after vaccination:1
Submitted: 1994-11-04
   Days after onset:7
Entered: 1994-11-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51020 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1691W / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M435KJ / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 711L2 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: full autopsy pending from hosp;
CDC Split Type:

Write-up: pt recvd vax; pt found dead on 28oct94 in crib by father at 10:30am; full autopsy pending; t at time of vax 99.6 rectally;


VAERS ID: 68428 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1994-09-26
Onset:1994-09-27
   Days after vaccination:1
Submitted: 1994-11-07
   Days after onset:41
Entered: 1994-11-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3D51083 / 2 - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0154A / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0693A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Pancreatic disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: na;~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: autopsy by county coroner
CDC Split Type:

Write-up: pt recvd vax; SIDS approx 30-36 hrs after vax;


VAERS ID: 68431 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Illinois  
Vaccinated:1994-10-31
Onset:1994-11-01
   Days after vaccination:1
Submitted: 1994-11-04
   Days after onset:3
Entered: 1994-11-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other       Purchased by: Public
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: 1994-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC Split Type:

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


VAERS ID: 68497 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-11-07
Entered: 1994-11-16
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1057A2 / 1 - / -

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

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 940097621

Write-up: report recvd from pt''s father who indicated that pt recvd vax & died the next day; COD: SIDS; parent has been transferred to Korea; no addtl details are available;


VAERS ID: 68503 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1994-11-07
Onset:1994-11-07
   Days after vaccination:0
Submitted: 1994-11-09
   Days after onset:2
Entered: 1994-11-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1510A2 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M0101D / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 707M / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Hypotonia, Pallor, Somnolence, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: cradle cap/seborrhea @ scalp
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: w/in 12 hrs of vax pt became lethargic, limp, lips white, irregular breathing; observed in ER for 12 hrs improved condition discharged home; apparent SIDS w/in 12 hrs; prev hx of SIDS in half sib @ 6 wks of age; t98 @ time of vax-no temp;


VAERS ID: 68505 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-14
Onset:1994-10-14
   Days after vaccination:0
Submitted: 1994-11-09
   Days after onset:26
Entered: 1994-11-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Cardiomegaly, Dyspnoea, Electrocardiogram ST segment elevation, Pneumonia, Pyrexia, Renal impairment, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-18
   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: Ampicillin, APAP #3; vit Fe, serax, Vit C
Current Illness: pedal edema $g 3 wks; r hip pain recurren
Preexisting Conditions: UTI; hx heart disease & heart failure
Allergies:
Diagnostic Lab Data: minimal urine output; good hematocrit 44; WBC count 5,000; platelet count 147,000; LDH 152; CPK 65; NA 143, K 3.7, Chloride 102, CO2 24, BUn 22, creatinine 2.6, glucose 117; PT & PTT WNL; 9AM VS BP 77/36, P162, R34, t101; lung-rhonchi;
CDC Split Type:

Write-up: pt recvd vax 14OCT93 by 15OCT pt was dyspneic, had a rt middle lobe pneumonia & then cardiogenic shock; BP by EMS 80/60; pt given med; 02 sat is 84% to 86%; pt c/o chest pain; EKG showed ST segment elevation inferiorly;cardiomegaly; t101


VAERS ID: 68523 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-11-14
Entered: 1994-11-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Coordination abnormal, Electroencephalogram abnormal, Encephalitis, Infection, Personality disorder, Pneumonia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
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: febrile illness; rash
Allergies:
Diagnostic Lab Data: MRI inc signal, corona radiata; EEG abn; MRI progression, abnormalities;
CDC Split Type: WAES94110237

Write-up: pt recvd vax & 6 months following vax pt became clumsy, & had generalized myoclonic szs each day; brain MRI scan revealed areas of inc signal in the corona radiata; EEG was abn; dec in social skills & use of language; stuporous; pneumonia;


VAERS ID: 68528 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Alaska  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-11-15
Entered: 1994-11-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / 1 - / -

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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Down''s synd; tetralogy of fallot;
Allergies:
Diagnostic Lab Data: Anti-PRP undetectable;
CDC Split Type: WAES94110155

Write-up: pt recvd vax & 34 days later devel a 2nd HIB infection; 34 days p/2nd HIB infect devel a third HIB infect of which pt succumbed; COD was fulminant meningitis; Anti-PRP antibody concentrations were nearly undetectable, indicating no response


VAERS ID: 68529 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Alaska  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-11-15
Entered: 1994-11-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / 1 - / -

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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: premature infant; lung disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES94110156

Write-up: pt recvd vax & 1 month later pt devel HIB meningitis; Anti-PRP antibody titer was 0.00 ug/ml @ the onset of the HIB infect; however the convalescent anti-PRP antibody titer was 0.72 ug/ml; dx w/pneum men, prog to septic shock & death


VAERS ID: 68559 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Mississippi  
Vaccinated:1994-06-24
Onset:1994-10-10
   Days after vaccination:108
Submitted: 1994-11-07
   Days after onset:28
Entered: 1994-11-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4K51154 / 3 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1414W / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005KP / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 362949 / 3 MO / PO

Administered by: Public       Purchased by: Private
Symptoms: Hepatocellular damage
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-31
   Days after onset: 21
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: died 4 mo post immun; hep A & B neg;
CDC Split Type: MS94060

Write-up: pt recvd dtp, hib, hep B 23jun94; no report of any rxn; pt became ill 10oct94 w/ some type of liver related illness; pt died 31oct94; autopsy not avail at this time;


VAERS ID: 68561 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Nevada  
Vaccinated:1994-10-20
Onset:1994-10-20
   Days after vaccination:0
Submitted: 1994-10-25
   Days after onset:5
Entered: 1994-11-18
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51667 / 1 LA / -

Administered by: Unknown       Purchased by: Public
Symptoms: Cardiac arrest, Convulsion, Hypotonia, Hypoventilation, Injury, Pulmonary oedema, Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: na;
Current Illness: na;
Preexisting Conditions: na;
Allergies:
Diagnostic Lab Data: autopsy done;
CDC Split Type: NV94028

Write-up: at 6:30pm, on playground w/ siblings, laid down crying for mom;brother thought crying for slide;picked pt up & help go down slide;collapsed/fainted,may have hit head;took to par;was limp & shallow breathing;taken to hosp;had cardiac arrest;


VAERS ID: 68571 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1994-11-04
Onset:1994-11-04
   Days after vaccination:0
Submitted: 1994-11-10
   Days after onset:6
Entered: 1994-11-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948032 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Coma, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; cardiac arrest w/ VF several hrs later; in hosp pt unconscious;


VAERS ID: 68773 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-11-25
Onset:1992-11-25
   Days after vaccination:0
Submitted: 1994-11-15
   Days after onset:720
Entered: 1994-11-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2A41126 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 - / -

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Coma, Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-25
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax on 25nov92 at 11:30am;asleep 12:10pm & put in crib;found unconscious & not breathing around 2pm;to hosp & pronounced dead at 2:30pm;


VAERS ID: 68886 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Illinois  
Vaccinated:1993-01-06
Onset:1993-01-07
   Days after vaccination:1
Submitted: 1994-11-07
   Days after onset:669
Entered: 1994-11-22
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-01
   Days after onset: 144
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC Split Type: IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


VAERS ID: 68944 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1994-11-16
Onset:1994-11-17
   Days after vaccination:1
Submitted: 1994-11-21
   Days after onset:4
Entered: 1994-11-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51010 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Shock, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Coumadin; Maxzide
Current Illness: NONE
Preexisting Conditions: NKDA; DMII, CHF, hypertension, Hypertriglyceridonic
Allergies:
Diagnostic Lab Data: rhythm strip-Vf
CDC Split Type:

Write-up: pt collapsed in kitchen-ambulance arrived pt in vent fib-coded-died; flu vax given 16NOV & pt died 17NOV;


VAERS ID: 69159 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1994-10-31
Onset:1994-10-31
   Days after vaccination:0
Submitted: 1994-11-23
   Days after onset:23
Entered: 1994-12-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51129 / 2 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Hypernatraemia, Hyperventilation, Hypotension, Hypothermia, Infection, Pneumonia, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-09
   Days after onset: 9
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: pt exp flu-like s/s @ 77yrs w/flu #1~ ()~~~In patient
Other Medications: Lanoxin, Calan, nitropatch; Haldol; Zantac
Current Illness: NONE
Preexisting Conditions: hx of CVA, organic brain synd, UTI, hypertension, UGI bleed, CAD, allergies Tetrapline, PCN, Prunes, coffee, cream, jello
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 31OCT94 1030AM & 1PM devel cold, clammy skin w/t97.2 ax; 2PM t103.3 R; 250PM T102.6R; Epi given-to ER dx febrile illness-poss viral synd, hypernatremia/chloremia, d/c ed on 1NOV; died 9NOV94;


VAERS ID: 69167 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arkansas  
Vaccinated:1994-10-05
Onset:1994-10-05
   Days after vaccination:0
Submitted: 1994-10-14
   Days after onset:9
Entered: 1994-12-02
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51152 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0571A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4J51152 / UNK LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0702L / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Apnoea, Bronchiolitis, Crying, Hypotonia
SMQs:, Peripheral neuropathy (broad), Interstitial lung disease (narrow), 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), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), 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: 1994-10-09
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: MD suspects SIDS vs vax rxn;
CDC Split Type: AR9489

Write-up: pt recvd vax; high pitched crying after vax;to er & hosp next night;MD gave apap & alcohol pads for leg;got better saturday;took bottle at 2am sunday;was found not breathing at 6am sunday;to er & pronounced dead;


VAERS ID: 69183 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:1994-11-14
Onset:1994-11-14
   Days after vaccination:0
Submitted: 1994-11-15
   Days after onset:1
Entered: 1994-12-02
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00774P / 3 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   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: capoten, ativan, nitrodur patch, micro K; reg ASA; bumex; nitrostat;
Current Illness: none;
Preexisting Conditions: calan sr, severe cardiomyopathy;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt came to ofc for lab work;wife requested he have flu vax;given in am, approx 15 min after leaving,wife called from hosp er,stated after getting into car pt Lt arm began twitching & head fell over to side;


VAERS ID: 69218 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1994-09-15
Onset:1994-10-07
   Days after vaccination:22
Submitted: 1994-10-12
   Days after onset:5
Entered: 1994-12-05
   Days after submission:54
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369909 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 374939 / 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: 1994-10-07
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94154

Write-up: pt recvd vax; pt died; possible SIDS death 7oct94;


VAERS ID: 69270 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Tennessee  
Vaccinated:1994-11-14
Onset:1994-11-17
   Days after vaccination:3
Submitted: 1994-11-29
   Days after onset:12
Entered: 1994-12-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 374962 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 21201 / 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: 1994-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: congenital CMV;
Allergies:
Diagnostic Lab Data: post mortem exam;
CDC Split Type:

Write-up: pt recvd vax; apparent SIDS death;


VAERS ID: 69390 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1993-09-21
Onset:1993-09-25
   Days after vaccination:4
Submitted: 1994-12-05
   Days after onset:436
Entered: 1994-12-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 352923 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1197A2 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 683M2 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Congenital anomaly, Convulsion, Enzyme abnormality, Gaze palsy, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-29
   Days after onset: 369
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: spinal tap,eeg''s,blood tests,cat scans,mri etc,(muscle biopsy showed mitochondrial abnormality?)
CDC Split Type:

Write-up: pt recvd vax; ex during few days after vax,noticed eyes roll back & became unresponsive on the 25th;called ems; had sz;spent wk in hosp;they could not find anything wrong;gave meds & sent home;cont to have sz on 4 different meds & more test


VAERS ID: 69447 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Arizona  
Vaccinated:1994-08-10
Onset:1994-08-15
   Days after vaccination:5
Submitted: 1994-12-09
   Days after onset:116
Entered: 1994-12-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0443A / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Antinuclear antibody, Arthralgia, Glomerulonephritis, Hypertension, Infection, Pneumonia, Renal failure, Systemic lupus erythematosus
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Hypertension (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 94
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: Cytoxan
Current Illness:
Preexisting Conditions: relatives w/systemic lupus erythematosus;
Allergies:
Diagnostic Lab Data: 6OCT94 renal biopsy class VI glomerulonephritis; NOV94 CXR complete opacification, lung; bronchoscopy coccidioidomycosis/adenovirus; ANA pos; DSDNA antibody pos; C3 complement low; C4 complement low;
CDC Split Type: WAES94091015

Write-up: pt recvd Hep B vax 10AUG94 & mid AUG94 devel malar rash, fever, arthralgias & hypertension; late SEP94, dx w/SLE w/nephritis & anemia; tx Pred; 6OCT94 renal biopsy revealed class VI glomerulonephritis; +ANA; pos DSDNA antibody; resp distres


VAERS ID: 69449 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Female  
Location: Maryland  
Vaccinated:1994-03-25
Onset:0000-00-00
Submitted: 1994-12-07
Entered: 1994-12-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 4 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-09-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Anti-HBS neg 28jan94; Anti-HBS neg;
CDC Split Type: WAES94061156

Write-up: pt recvd 1st,2nd & 3rd dose of hep B on 7dec92,27jan93,29jun93,respectively; Anti-HBS neg 28jan94;anoth vax of hep adm 25mar94;tests revealed anti-HBS neg;subsequently pt died of a myobacterium ovium infectious disease;


VAERS ID: 69495 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: North Dakota  
Vaccinated:1994-11-07
Onset:1994-11-08
   Days after vaccination:1
Submitted: 1994-12-06
   Days after onset:28
Entered: 1994-12-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51084 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0702D / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Gastroenteritis, Pneumonia, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 9
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: Keslex
Current Illness: Bronchitis
Preexisting Conditions: bronchitis
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: ND94021

Write-up: t102, lethargic, vomited x1, gastroenteritis, loose stools;


VAERS ID: 69496 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-10-10
Onset:0000-00-00
Submitted: 1994-12-05
Entered: 1994-12-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3A37083 / 1 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560KF / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 698A3 / 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: 1994-11-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 1 wk premature/low birthwgt
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94036

Write-up: pt recvd vax 10OCT94 no adverse rxn''s; SIDS death;


VAERS ID: 69724 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Connecticut  
Vaccinated:1994-12-09
Onset:1994-12-15
   Days after vaccination:6
Submitted: 1994-12-15
   Days after onset:0
Entered: 1994-12-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1223ASB / 3 - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1203A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: IVER-secondary to toxemia; PBCC 36wk; poor feeding till 1mo;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt found unresponsive in crib 10AM; CPR @ home, intubated by EMT, could not be resuscitated;


VAERS ID: 69731 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Wisconsin  
Vaccinated:1994-11-30
Onset:1994-12-01
   Days after vaccination:1
Submitted: 1994-12-08
   Days after onset:7
Entered: 1994-12-20
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380997 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 381914 / 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: 1994-12-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: brought to ER on 1DEC apparently had been put down for a nap that afternoon when mom checked on pt was unresponsive; preliminary autopsy results consistent w/SIDS;


VAERS ID: 69733 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Ohio  
Vaccinated:1994-12-12
Onset:1994-12-12
   Days after vaccination:0
Submitted: 1994-12-16
   Days after onset:4
Entered: 1994-12-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51146 / UNK - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51023 / UNK - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61023 / 3 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-12
   Days after onset: 0
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:
Other Medications: Lasix, Digoxin, Ferinsol
Current Illness: rt hypoplastic ventricle
Preexisting Conditions: congenital heart defect; scheduled for surgery in JAN95
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5748

Write-up: found not breathing by grandmother; taken to ER & revived; airlifted to hosp expired 12DEC94;


VAERS ID: 69837 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1994-12-19
Onset:0000-00-00
Submitted: 1994-12-20
Entered: 1994-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380970 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 984940 / 1 MO / PO

Administered by: Private       Purchased by: Other
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: 1994-12-20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: episodes of bronchiolitis, tx 25nov94;
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: pt recvd vax; pt fussy at noc after immun; sleeping quietly 3am; found dead by mom at approx 6:30am;


VAERS ID: 69840 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Florida  
Vaccinated:1994-12-14
Onset:1994-12-15
   Days after vaccination:1
Submitted: 1994-12-21
   Days after onset:6
Entered: 1994-12-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380999 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1512B2 / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382944 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Acidosis, Cyanosis, Dyspnoea, Hypertonia
SMQs:, Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-21
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: na;~ ()~~~In patient
Other Medications: vitamin, amoxicillin, dimetapp;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax;on 15dec at 2pm was found by daycare to be cyanotic,rigid & difficulty of breathing;to hosp & found to be in severe metabolic acidosis;


VAERS ID: 69942 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-03-18
Onset:1994-08-01
   Days after vaccination:136
Submitted: 1994-12-20
   Days after onset:141
Entered: 1994-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1688W / 3 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 1042V / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, CSF test abnormal, Cardiac arrest, Condition aggravated, Drug ineffective, Infection, Meningitis, Sepsis
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 (narrow), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   Days after onset: 105
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: phenobarbital 15 mg po every other day; prednisone;
Current Illness:
Preexisting Conditions: developmental delay, infantile spasms/seizure disorder; NKDA; allergy, Dilantin; encephalopathy; mental retardation, moderate; medical hx: GE reflux, fundoplication, tonsillectomy, adenoidectomy, hypotonia;
Allergies:
Diagnostic Lab Data: lumbar puncture 11nov94 pneumoccocal type 19;
CDC Split Type: WAES94120230

Write-up: pt recvd vax; pt devel hand, foot & mouth disease;on 11nov94, dx w/ pneumoccocal meningitis;adm to hosp x 2 days;lab evaluation of spinal fluid revealed pneumoccocal serotype 19;on 14nov pt died of cardiac arrest;


VAERS ID: 69952 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Alabama  
Vaccinated:1994-12-15
Onset:1994-12-15
   Days after vaccination:0
Submitted: 1994-12-21
   Days after onset:6
Entered: 1994-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9445

Write-up: pt recvd vax; found dead by his wife approx 2 hrs p/ vax;


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