|
VAERS ID: |
376710 (history) |
Form: |
Version 1.0 |
Age: |
0.53 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 2010-01-08 |
Onset: | 2010-01-11 |
Days after vaccination: | 3 |
Submitted: |
2010-01-12 |
Days after onset: | 1 |
Entered: |
2010-01-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3431AA / UNK |
UN / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U3167FA / UNK |
UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D39016 / UNK |
UN / IM |
Administered by: Private Purchased by: Private Symptoms: Death,
Unresponsive to stimuli SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-11
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse. |
|
VAERS ID: |
376969 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 2010-01-06 |
Onset: | 2010-01-09 |
Days after vaccination: | 3 |
Submitted: |
2010-01-14 |
Days after onset: | 5 |
Entered: |
2010-01-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR |
UP035BA / 1 |
RA / IM |
Administered by: Private Purchased by: Public Symptoms: Coagulopathy,
Death,
Drug interaction,
International normalised ratio increased SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-11
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: COUMADIN Current Illness: NonHodgkins Lymphoma Preexisting Conditions: lymphoma; chronic DVT Allergies: Diagnostic Lab Data: Increased INR CDC Split Type:
Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation. |
|
VAERS ID: |
376990 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 2010-01-08 |
Onset: | 2010-01-10 |
Days after vaccination: | 2 |
Submitted: |
2010-01-14 |
Days after onset: | 4 |
Entered: |
2010-01-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS |
500805P / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-10
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: no Preexisting Conditions: unknown Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: unknown |
|
VAERS ID: |
377750 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 2010-01-14 |
Onset: | 2010-01-16 |
Days after vaccination: | 2 |
Submitted: |
2010-01-21 |
Days after onset: | 5 |
Entered: |
2010-01-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS |
102148P1 / 1 |
LA / IM |
Administered by: Public Purchased by: Unknown Symptoms: Coronary artery disease,
Death SMQs:, Other ischaemic heart disease (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-16
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: ASA; Lisinopril 20mg; PLAVIX; Simvastatin 40mg; NITROQUICK; Metoprolol 25mg; albuterol Current Illness: F/up HTN Preexisting Conditions: HTN; Hyperlipidemia; Coronary atherosclerois Allergies: Diagnostic Lab Data: scheduled CMP, Lipid panel - Not done CDC Split Type:
Write-up: Death apparent heart attack 1/16/10. Pt. w/ CAD/ angioplasty 7/09 w/ stent placement. On multiple meds, smoker, denied symptoms 1/14/10. |
|
VAERS ID: |
378027 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 2010-01-12 |
Onset: | 2010-01-15 |
Days after vaccination: | 3 |
Submitted: |
2010-01-21 |
Days after onset: | 6 |
Entered: |
2010-01-25 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR |
UP074AA / 1 |
LA / IM |
Administered by: Other Purchased by: Public Symptoms: SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-15
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Unknown Current Illness: None reported Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: Unknown CDC Split Type:
Write-up: No adverse reactions within first hour after vaccination administered. Notified of client''s death on 01/15/2010. |
|
VAERS ID: |
378368 (history) |
Form: |
Version 1.0 |
Age: |
0.51 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 2010-01-21 |
Onset: | 2010-01-21 |
Days after vaccination: | 0 |
Submitted: |
2010-01-26 |
Days after onset: | 5 |
Entered: |
2010-01-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3496AA / 3 |
- / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U3209AA / 1 |
RL / IJ |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1251Y / 3 |
LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D84740 / 2 |
LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0318Y / 3 |
MO / PO |
Administered by: Other Purchased by: Public Symptoms: Death,
Intensive care,
Meningitis,
Respiratory disorder SMQs:, Acute central respiratory depression (broad), Noninfectious meningitis (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-26
Days after onset: 5
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 known Preexisting Conditions: none Allergies: Diagnostic Lab Data: diagnosis: meningitis. CDC Split Type:
Write-up: upper respiratory complaints - admitted to ICU. |
|
VAERS ID: |
379004 (history) |
Form: |
Version 1.0 |
Age: |
0.11 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 2010-01-20 |
Onset: | 2010-01-21 |
Days after vaccination: | 1 |
Submitted: |
2010-02-01 |
Days after onset: | 11 |
Entered: |
2010-02-01 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB762BA / 2 |
RL / IM |
Administered by: Public Purchased by: Public Symptoms: Asphyxia,
Death,
Sudden infant death syndrome SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-21
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: none Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: well child check 1-20-2010. Infant received Hepatitis B vaccine on 1-20-2010. Aunt found infant ,on the morning of 1-21-2010, dead in the bed with mother,who was asleep. suspect SIDS or accidental suffocation. |
|
VAERS ID: |
379119 (history) |
Form: |
Version 1.0 |
Age: |
0.17 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 2010-01-13 |
Onset: | 2010-01-30 |
Days after vaccination: | 17 |
Submitted: |
2010-02-02 |
Days after onset: | 3 |
Entered: |
2010-02-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3261AA / 1 |
LL / UN |
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBHB730AA / UNK |
RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D48928 / 1 |
RL / UN |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DA802A / 1 |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-30
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NYSTATIN oral soln. Current Illness: Thrush Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: None stated. |
|
VAERS ID: |
379507 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Male |
Location: |
Indiana |
Vaccinated: | 2010-01-21 |
Onset: | 2010-01-21 |
Days after vaccination: | 0 |
Submitted: |
2010-02-04 |
Days after onset: | 14 |
Entered: |
2010-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS |
102135P1 / UNK |
- / IJ |
Administered by: Other Purchased by: Public Symptoms: Death,
Eating disorder,
Hypotonia,
Lethargy,
Parkinson's disease SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-25
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: Lexapro tab 10 mg Amitiza Caps 24mcg Nasonex Scent Free Ns Spr 17g 50mcg Omeprazole Caps 20mg Requip Tabs 0.25mg Xalatan Opth Soln 2.5ml 0.005% Carbidopa/levodopa Tabs 25/100mg Megestrol Oral Susp 40mg/ml Current Illness: Parkinson''s Disease Preexisting Conditions: Parkinson''s Disease Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Lethargic, stopped drinking, stopped eating on the 21st. On the 22nd his arms layed limp at his sides when previously they were rigid and locked from the Parkinson''s. He would not eat or drink on the 22nd. |
|
VAERS ID: |
379725 (history) |
Form: |
Version 1.0 |
Age: |
0.18 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: | 2010-01-08 |
Onset: | 2010-01-12 |
Days after vaccination: | 4 |
Submitted: |
2010-02-08 |
Days after onset: | 27 |
Entered: |
2010-02-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3433AA / 1 |
UN / IM |
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHAVB359AA / UNK |
UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D84740 / 1 |
UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0181Y / 1 |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Death,
Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2010-01-12
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: SIDS 1/12/09 CDC Split Type:
Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated. |
|