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This is VAERS ID 152834

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152834
VAERS Form:
Age:6.0
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 3B51129 / 1 - / IM
HEP: RECOMBIVAX HB / MSD 1790W / 1 - / IM
HIBV: ACT-HIB / CONNAUGHT LABS 3B51129 / 1 - / IM
OPV: ORIMUNE / LEDERLE 0699B / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, EEG ABNORM, ENCEPHALOPATHY, CATARACT, GROWTH RETARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type': hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost ""immediately"" we could tell that he had vision problems and after a few months he"had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small ""jerks"". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 month


Changed on 12/30/2006

VAERS ID: 152834 Before After
VAERS Form:
Age:6.0
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 3B51129 / 1 - / IM
HEP: RECOMBIVAX HB / MSD 1790W / 1 - / IM
HIBV: ACT-HIB / CONNAUGHT LABS 3B51129 / 1 - / IM
OPV: ORIMUNE / LEDERLE 0699B / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, EEG ABNORM, ENCEPHALOPATHY, CATARACT, GROWTH RETARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, MRI''''s, 2 CT scans, 3 EEG''s EEG''''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. EEG''''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type': hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost ""immediately"" /"immediately/" we could tell that he had vision problems and after a few months he"had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small ""jerks"". /"jerks/". The MD''s MD''''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 month mont


Changed on 12/8/2009

VAERS ID: 152834 Before After
VAERS Form:
Age:6.0 0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-09 2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1790W / 1 - / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0699B / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation, CONVULS, EEG ABNORM, ENCEPHALOPATHY, CATARACT, GROWTH RETARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''''s, MRI''s, 2 CT scans, 3 EEG''''s EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''''s. EEG''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type': hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis (blank)

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost /"immediately/" "immediately" we could tell that he had vision problems and after a few months he"had he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small /"jerks/". "jerks". The MD''''s MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 mont months he was unable t7 hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 3/12/2012

VAERS ID: 152834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0699B / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ;UNK. ?;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable t7 hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 9/12/2012

VAERS ID: 152834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0699B / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ?;UNK. ;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable t7 hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 12/11/2012

VAERS ID: 152834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0699B / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ;UNK. ?;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable t7 hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 1/13/2014

VAERS ID: 152834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0699B / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ?;UNK. ;UNK. HEPATITIS B;1;.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nm
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable t7 hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 5/14/2017

VAERS ID: 152834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0699B / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ;UNK. HEPATITIS B;1;.00;In ~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nm nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable t7 to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 9/14/2017

VAERS ID: 152834 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 1 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 1 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 1 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 2/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~Hep ?~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 6/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ?~Hep ~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 8/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~Hep ?~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 9/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ?~Hep ~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 10/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~Hep �~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 11/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: �~Hep ?~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 12/14/2018

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ?~Hep �~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.


Changed on 2/14/2019

VAERS ID: 152834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Wisconsin
Vaccinated:1994-05-12
Onset:1994-06-09
Submitted:0000-00-00
Entered:2000-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1790W / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3B51129 / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cataract, Convulsion, Dyskinesia, Electroencephalogram abnormal, Encephalopathy, Mental retardation severity unspecified, Vision abnormal neonatal, Growth retardation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: �~Hep ?~Hep B (no brand name)~1~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of premature birth (37 weeks), low birth weight, descended testicles, asthma (dx at 2 1/2 yrs) pneumonia, sinus infections and bronchitis
Allergies:
Diagnostic Lab Data: Battery of tests, 2 MRI''s, 2 CT scans, 3 EEG''s and all wnl. He had 17 blood draws to check for any metabolic abnormalties, had 1 VER(visually evoked response) during 1 of his EEG''s. His growth hormone level was nml, blood sugar level was nml.
CDC 'Split Type':

Write-up: The pt was given his first dose of Hep B vaccine at 2 days old. He was a premature child born at 37 weeks and a low birth weight of 4 lbs. 15 oz. The parents state almost "immediately" we could tell that he had vision problems and after a few months he had developmental delays. At less than 3 months old, the pt was given DPT, Polio and Hib. Within about 6 weeks, he developed small "jerks". The MD''s office assured her it was probably nothing. Later these were diagnosed as myoclonic seizures. At 4 months he was unable to hold his head up, roll from tummy to back, push up on arms. At 5 months he received his second doses of the vaccines. Within 4 weeks, he started to have simple partial seizures along with the myoclonic seizures. A neurologist made the diagnoses and prescribed Phenobarbital. Several tests were ordered. At this time the childs growth slowed down as did his brain growth. He was diagnosed as microcep developmentally delayed epileptic and having static encephalopathy (later this was changed to unknown encephalopathy). An ophthalmologist states that the child eyes had developed correctly, but at 19 months the child had cataracts in both eyes and had surgery to remove them. The pertussis part of the vax was discontinued. The MD wanted the child to have a sleep apnea test scheduled for the night of 5/2/00. The child unexpectedly passed away that morning. Autopsy states cause of death acute seizure activity due to chronic seizure disorder.

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