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Found 8,406 cases where Patient Died

Table

   
AgeCountPercent
< 3 Years3,85445.85%
3-6 Years1671.99%
6-9 Years770.92%
9-12 Years800.95%
12-17 Years1952.32%
17-44 Years4094.87%
44-65 Years4485.33%
65-75 Years4044.81%
75+ Years7268.64%
Unknown2,04624.34%
TOTAL8,406100%

Case Details

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VAERS ID: 25003 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: Texas  
Vaccinated:1990-01-29
Onset:1990-02-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259962 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 241950 / 4 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.


VAERS ID: 25026 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Washington  
Vaccinated:1990-01-12
Onset:1990-01-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 229974 / UNK - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9A11092 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 244970 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-14
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio


VAERS ID: 25028 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1989-05-24
Onset:1990-06-24
   Days after vaccination:396
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8L01022 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Meningitis
SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-06-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted with H-Flu meningitis on 24Jun90. Pt expired on 25Jun90. Pt received HIB vaccine at 18 months of age.


VAERS ID: 25520 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:1988-02-03
Onset:1990-02-17
   Days after vaccination:745
Submitted: 0000-00-00
Entered: 1990-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tolbutamide, Vitamin B, Vitamin C
Current Illness: Presenile dementia; Diabetes mellitus
Preexisting Conditions: Renal dialysis; Renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES90060030

Write-up: 71 yr old male w/presenile dementia, diabetes mellitus, & renal failure received Hepatitis B vaccine, recombinant, 40 mcg, IM. Dialysis shunt became infected Dx w/sepsis therapy initiated w/flucloxacillin, however pt died that day.


VAERS ID: 25526 (history)  
Form: Version 1.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:1990-06-08
Onset:1990-06-17
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1990-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal pain, Acidosis, Anaphylactoid reaction, Cardiac arrest, Cardiac failure, Haematemesis, Injection site pain, Pancreatitis, Pyrexia, Renal failure
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-06-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 30Jul90- cause of death: anaphylactic shock; the poisonous efectof ingested food stuff causing an accute systemic anaphylactic response which led to acute myocardial failure & ended in cardo-respiratory arrest.
CDC Split Type: CO3526

Write-up: Pt given Imovax rabies on 9-JUN-90 c/o sore arm. 17-JUN-90 pt. had fever & abd tenderness. Family member states worsened. While traveling w/husband pt. began to vomit blood. Taken to ER & admittedto intensive care. Pt had a cardiac arrest


VAERS ID: 25530 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Indiana  
Vaccinated:1990-06-04
Onset:1990-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-06-05
   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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS


VAERS ID: 25534 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: New York  
Vaccinated:1987-12-09
Onset:1990-06-25
   Days after vaccination:929
Submitted: 0000-00-00
Entered: 1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 181666 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-06-25
   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: 9001160.01

Write-up: 4 1/2 yr old child 25Jun90/w positive blood culture for h. Influenzae type B. Child received immunization on 9Dec87


VAERS ID: 25535 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Ohio  
Vaccinated:1990-03-28
Onset:1990-03-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271962 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259949 / 2 - / -

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: 1990-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy revealed no pathology in any organ system that could explain the death of this infant, therefore, this is a case of sudden death syndrome.
CDC Split Type: 9000592.01

Write-up: normal 4 moth old infant received DTP/OPV in office at on 28Mar90, put to bed at 10:00pm; found dead at 10:30 pm.


VAERS ID: 25543 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Unknown  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Diarrhoea, Respiratory disorder
SMQs:, Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001123.01

Write-up: 4 month old infant received first DTP/OPV immun. & had no immediate problems, was apparently well & healthy. 9-10 days later, developed repiratory symptoms & diarrhea, then found dead the following day.


VAERS ID: 25553 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1990-06-25
Onset:1990-06-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9J01114 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.


VAERS ID: 25556 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:1989-10-20
Onset:1989-10-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 42622/1644R / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-10-25
   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: no relevant history
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy-strep sepsis, The physician & autopsy pathologist felt that the pt''s dealth was not related to vaccination.
CDC Split Type: WAES89100782

Write-up: MD reported pt initially vac. w/ MMR live at 15 mo''s was vac. w/ booster MMR on 10-20-89 along w/ DTP. Pt died 10-25-89. Autopsy = overwhelming strep. sepsis. MD and autopsy pathologist felt pt death not related to vaccination.


VAERS ID: 25569 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:1987-11-10
Onset:1987-12-29
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MU: MUMPS (MUMPSVAX I) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Chest pain, Electrocardiogram abnormal, Myocarditis
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: Autopsy revealed a grossly normal pancreas. Additional info. requested.
CDC Split Type: WAES90060971

Write-up: Pt vacc. /w Mumpsvax 1st dose in response to local mumps epidemic, 2 wks later he developed chest pain & abnormal ECG. Admitt to hospital & died 2 days later /p admission /w DX of myocarditis.MD could not establish a causal relationship.


VAERS ID: 25581 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Oregon  
Vaccinated:1990-01-25
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 585A4 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-05-19
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: no known allergies, non responder to previous 3 dose /w MSD vaccine
Allergies:
Diagnostic Lab Data: 10Jan90 titer test = non responsive, Herpes varicella recovered from brain
CDC Split Type: EBU900170

Write-up: Pt given a series of 3 MSD Hep-B vaccines, & 2 Engerix-B vaccines due to being non responder. Pt developed encephalitis & died. Herpes varicella recovered form brain


VAERS ID: 25683 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Missouri  
Vaccinated:1990-06-29
Onset:1990-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / 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: 1990-07-02
   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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.


VAERS ID: 25703 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Virginia  
Vaccinated:1990-06-26
Onset:1990-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / 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: 1990-06-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


VAERS ID: 25780 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maryland  
Vaccinated:1990-07-26
Onset:1990-07-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown       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: 1990-07-29
   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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC Split Type: 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


VAERS ID: 25799 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: California  
Vaccinated:1988-09-28
Onset:1988-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Brain oedema, Cerebral haemorrhage, Coagulopathy, Convulsion, Meningitis, Respiratory disorder, Sepsis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (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: 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: hx of croup once in 08/87; Congenital hip dysplasia
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3592

Write-up: Haemophilus influenzae, type B meningitis & sepsis. Complications; seizures, cerebral edema, intracerebral bleed, DIC & ARDS.


VAERS ID: 25870 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1990-08-24
Onset:1990-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 61706 / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt vaccinated with DTP/OPV became irritable, body temp 100.f. No vomiting or other symptoms; Fell asleep at 6AM when parents went to wake him for feeding noted to be unresponsive. Paramedics were called brought to ER.


VAERS ID: 25912 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alaska  
Vaccinated:1990-06-08
Onset:1990-06-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B11061 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0605H / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: elevated temperature of 103+, projectile vomitting, continued high pitched crying. Medical examination by treating physician & released.


VAERS ID: 25913 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Unknown  
Vaccinated:1990-01-24
Onset:1990-01-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See WORM for autopsy report, emergency room reports
CDC Split Type:

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


VAERS ID: 25975 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Florida  
Vaccinated:1990-08-27
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 617M / 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: 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: Pt vaccinated with DTP/OPV no acute rx reported by mother 48 hrs post immunization


VAERS ID: 25989 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Hawaii  
Vaccinated:1989-09-12
Onset:1989-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9G101042 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 595 / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal distension, Agitation, Atelectasis, Dyspnoea, Gastric dilatation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-09-13
   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: Premature infant w/numerous medical problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV developed cardiorespiratory arrest less than 24 hrs after vax. Pt noted to have abd distension and fussiness along with some respiratory distress prior to arrest. Pt was premature infant w/several med problems.


VAERS ID: 25994 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Wyoming  
Vaccinated:1989-12-05
Onset:1989-12-29
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2068P / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298B1 / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asphyxia, Brain oedema, Immune system disorder, Infection, Necrosis, Pulmonary haemorrhage, Pulmonary oedema, Splenomegaly
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pedizole, Tassi Organdin
Current Illness: Otitis, Bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy was contradictory /w no conclusions & many signs of Pertussis reactions.
CDC Split Type:

Write-up: Casey was given DPT/MMR/OPV while still on anitbiotic Pedizole and tassii organdin for otitis & bronchitis. He appeared happy & well until he died in his sleep. Shots were given on 5DEC89.


VAERS ID: 26080 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Massachusetts  
Vaccinated:1990-05-18
Onset:1990-05-19
   Days after vaccination:1
Submitted: 1990-09-18
   Days after onset:122
Entered: 1990-09-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP270 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 268953 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-05-19
   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: Hydorcortisone for rash
Current Illness:
Preexisting Conditions: Heart M gr I/VI (Non significant) Premature (36-37 wks)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV found to have funny breathing early AM later mother found her not breathing.


VAERS ID: 26112 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-09-11
Onset:1990-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-09-26
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: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-13
   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:

Write-up: Child immunized with DTP/OPV vaccines on 11SEP90. Sudden Infant Death Syndrome.


VAERS ID: 26159 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:1990-09-20
Onset:1990-09-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-20
   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: Methyprednisolone, Verapamil, Proventil, Albuterol, Anhydrous Theophylline
Current Illness: Severe Bronchial Asthma
Preexisting Conditions: Pt was hospitalized 2-3 yrs ago for hypertensive Crisis & Severe Bronchial Asthma.
Allergies:
Diagnostic Lab Data: HGT=5''6"; WGT=99lbs; Morning of 20SEP90 BP=142/86;P=72/min®.
CDC Split Type: 904090001

Write-up: Pt vaccinated with FLUOGEN who has severe bronchial asthma seen in MD ofc well VS stable & chest clear, death & respiratory arrest.


VAERS ID: 26175 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Washington  
Vaccinated:1990-09-05
Onset:1990-09-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1990-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 0F11072 / 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: 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: Pt vaccinated with DTP 5SEP90 developed SIDS.


VAERS ID: 26196 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Female  
Location: Michigan  
Vaccinated:1990-08-20
Onset:1990-08-22
   Days after vaccination:2
Submitted: 1990-10-02
   Days after onset:41
Entered: 1990-10-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


VAERS ID: 26209 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Unknown  
Location: North Carolina  
Vaccinated:1990-09-11
Onset:1990-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy pending - copy of report requested
CDC Split Type: 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


VAERS ID: 26224 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Missouri  
Vaccinated:1990-07-31
Onset:1990-08-05
   Days after vaccination:5
Submitted: 1990-10-06
   Days after onset:62
Entered: 1990-10-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH - / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Face oedema, Hypersensitivity, Oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-08-11
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hypoglycemic of Newborn; R/O Sepc as newborn
Allergies:
Diagnostic Lab Data: Chest X-Ray Neg; All lab work neg; SGOT = 200; NA 123; EKG neg; ECHO heart neg
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed puffy eyes seen in office dx allergy given Benadryl; Seen 8AUG some vomiting, 9AUG admitted more puffiness & edematous See WORM for more details.


VAERS ID: 26229 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1990-09-06
Onset:1990-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-07
   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: Acetaminophen
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood cultures at time of death grew E. Coli, TEXT: death resulted
CDC Split Type:

Write-up: Pt vacc. /w DTP 24 hrs later child died. Child had URI, /p shot fever, she fed normally 8 hrs before death. In AM mother went to dress child, child blinked, gasped & then arrested. F/U DR called 30Oct90 lab data not consistant /w moms hx


VAERS ID: 26236 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:1989-10-03
Onset:1990-01-01
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. CP284 / 4 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hepatic failure, Pulmonary oedema, Sepsis
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-29
   Days after onset: 28
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: CVA; Seizure disorder; Diabetes mellitus; End stage renal disease; Hypertension; Ischemic heart disease
Allergies:
Diagnostic Lab Data: No relevant data.
CDC Split Type: WAES90011108

Write-up: Pt w/diabetes mellitus vaccinated w/Recombivax HB entered a study comparing safey & efficacy of hepatitis B (Pre S2+S) vaccine Reocmb & Hepatitis B Vac Recomb in dialysis pt. Was hospitalized because pulmonary edema then sepsis & liver fail


VAERS ID: 26239 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: New Hampshire  
Vaccinated:1989-07-27
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 244984 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 250939 / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Hypotonia, Insomnia, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? 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: 9001575.01

Write-up: Pt vaccinated with DTP/OPV had loss of head control, screaming & vomiting, sleep loss; limbs tense also developed seizures. Hospitalized multiple times between 9-12/89. Received DT, condiiton worsened; died 18ARP90.


VAERS ID: 26241 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1989-06-20
Onset:1989-06-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 232968 / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: CSF test abnormal, Cerebrovascular disorder, Convulsion, Delirium, Encephalopathy, Hepatic necrosis, Neuropathy, Pneumonia
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-03-28
   Days after onset: 278
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 60 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001578.01

Write-up: Pt vaccinated with DTP then death occurred 3/90. Cause of death listed as reaction to DTP vaccination.


VAERS ID: 26250 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: California  
Vaccinated:1990-08-29
Onset:1990-08-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 265925 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cyanosis, Hypokinesia, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-08-31
   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:
Allergies:
Diagnostic Lab Data: Autopsey - SFC&C coroner
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV found shortly after being put down for nap unresponsibe, apnea, blue & resuscitation unsuccessful. Verbal autopsey Dr SIDS.


VAERS ID: 26282 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Nevada  
Vaccinated:1989-12-01
Onset:1989-12-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 5794F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-03
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001626.01

Write-up: CDC Reports that 3 mo old infant received 1st DTP/OPV on 1DEC89 & died 3DEC89.


VAERS ID: 26283 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oklahoma  
Vaccinated:1989-08-23
Onset:1989-08-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 226947 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-08-25
   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: 9001627.01

Write-up: CDC Reports that 3 mo infant received DTP/OPV on 23AUG89 and died 25AUG89.


VAERS ID: 26284 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1990-02-27
Onset:1990-03-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256927 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-03-03
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001628.01

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 27FEB90 and died 3MAR90.


VAERS ID: 26285 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Georgia  
Vaccinated:1990-03-19
Onset:1990-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0599C / UNK MO / PO

Administered by: Unknown       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: 1990-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001628.02

Write-up: CDC Reports: 5 mo infant received DTP/OPV on 19MAR90 and died 20AMR90. Patient was given Tylenol for a low grade fever 3 hrs before death.


VAERS ID: 26286 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1989-10-12
Onset:1989-11-08
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0589H / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-08
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001629.01

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 12OCT89 and died 8NOV89.


VAERS ID: 26287 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1989-12-15
Onset:1989-12-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0589H / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001629.02

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 11DEC89 and died 15DEC89.


VAERS ID: 26288 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1989-11-21
Onset:1989-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0599C / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001629.03

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 8NOV89 and 21NOV89.


VAERS ID: 26289 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1989-10-11
Onset:1989-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 247439 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-10-13
   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: Known balanced translocation, chromosome 245 cause of death unknown, post WNL, Tox pending.
CDC Split Type: 9001629.04

Write-up: CDC reports: 3 mo infant received DTP/OPV on 11OCT89 and died 13OCT89.


VAERS ID: 26290 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Louisiana  
Vaccinated:1990-01-25
Onset:1990-02-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256965 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0592B / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-02-03
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001630.01

Write-up: CDC reports: 5 mo infant received DTP/OPV on 25JAN90 and died 3FEB90.


VAERS ID: 26291 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1989-11-08
Onset:1989-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 253980 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256928 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-08
   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:
Allergies:
Diagnostic Lab Data: Autopsy performed
CDC Split Type: 9001631.01

Write-up: CDC reports 4 mo infant received DTP/OPV on 8NOV89 and died 4 hrs later.


VAERS ID: 26292 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1989-10-31
Onset:1989-11-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 253980 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 250939 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-07
   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: Gross post mortem negative; Autopsy performed.
CDC Split Type: 9001631.02

Write-up: CDC Reports: 3 mo infant received DTP/OPV on 31OCT89 and died 7NOV89.


VAERS ID: 26293 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1989-09-27
Onset:1989-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0594F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-09-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No Autopsy. SIDS on death certificate, also natural
CDC Split Type: 9001633.01

Write-up: CDC Reports: 2mo infant received DTP/OPV on 27SEP89 and died 29SEP89.


VAERS ID: 26294 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-01-23
Onset:1990-01-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0594F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No illness following previous immunization.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001633.02

Write-up: CDC Reports: 5 mo infant receivd DTP/OPV on 23JAN90 and died 24JAN90.


VAERS ID: 26295 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1989-11-14
Onset:1989-11-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0593D / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-11-17
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001633.03

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 14NOV89 and died 17NOV89.


VAERS ID: 26296 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1989-12-12
Onset:1989-12-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0600H / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001635.01

Write-up: CDC Reports: 3 mo infant received DTP/OPV on 12DEC89 and died same day. Infant was put down for a nap approx 1PM. Mother checked on infant approx 4PM no response dead on arrival at hospital.


VAERS ID: 26297 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Vermont  
Vaccinated:1989-12-14
Onset:1990-01-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259943 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Brain oedema, Hypoxia, Infection, Lung disorder, Petechiae, Respiratory disorder, Sudden infant death syndrome
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-01
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001636.01

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 14DEC89 and died 1JAN90.


VAERS ID: 26318 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-10-09
Onset:1990-10-11
   Days after vaccination:2
Submitted: 1990-10-17
   Days after onset:6
Entered: 1990-10-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private       Purchased by: Private
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: 1990-10-12
   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: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC Split Type:

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


VAERS ID: 26336 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Maryland  
Vaccinated:1990-07-26
Onset:1990-07-29
   Days after vaccination:3
Submitted: 1990-10-23
   Days after onset:86
Entered: 1990-10-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-07-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC Split Type:

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


VAERS ID: 26483 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Connecticut  
Vaccinated:1989-07-27
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 244984 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 250939 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Insomnia, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-04-18
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: 900157501

Write-up: Pt vaccinated with 1st DTP/OPV on 27Jul89, developed loss of head control, screaming & vomiting, had sleep loss, limbs tense and developed seizures. Hospitalized many times between Sep-Dec89, received DT, condition worsened; Died 18APR90.


VAERS ID: 26463 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:1990-10-01
Onset:1990-10-01
   Days after vaccination:0
Submitted: 1990-10-17
   Days after onset:16
Entered: 1990-11-02
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-16
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC Split Type: 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


VAERS ID: 26484 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: California  
Vaccinated:1990-09-27
Onset:0000-00-00
Submitted: 1990-10-30
Entered: 1990-11-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES - / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Chills, Pain, Pyrexia, Vasodilatation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-06
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/HIB/MMR found apneic in crib on 06OCT90.


VAERS ID: 26592 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-10-03
Onset:1990-10-26
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 1990-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Estrace Cream
Current Illness:
Preexisting Conditions: Premature birth 2lbs 13 oz
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Pt vaccinated with PROHIBIT DOA to Hosp.


VAERS ID: 26593 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1990-10-29
Onset:1990-10-31
   Days after vaccination:2
Submitted: 1990-11-02
   Days after onset:2
Entered: 1990-11-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK 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: 1990-10-31
   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: Nystatin Ointment
Current Illness: Diaper Rash
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV no adverse effects according to father; Pt was fine the day after immunization. Pt discovered not breathing at 2AM 31OCT.


VAERS ID: 26603 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Colorado  
Vaccinated:1990-10-24
Onset:1990-10-29
   Days after vaccination:5
Submitted: 1990-11-05
   Days after onset:7
Entered: 1990-11-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-29
   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: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


VAERS ID: 26655 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:1990-10-18
Onset:1990-10-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Back pain
SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


VAERS ID: 26668 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Unknown  
Location: New York  
Vaccinated:1990-11-08
Onset:1990-11-11
   Days after vaccination:3
Submitted: 1990-11-13
   Days after onset:2
Entered: 1990-11-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Laryngitis, Otitis media, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-11
   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: Mild cold
Preexisting Conditions: normal child
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3705

Write-up: Pt vaccinated with PROHIBIT mild cold at time of injection. Seen again 11NOV for subjective fever, worsening cold tugging at ears. Dx w/Otitis. Prescribed Augmentin, Codeine & Tylenol. Child found dead 6 hrs later in bed. Normal child


VAERS ID: 26694 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted: 1990-11-16
Entered: 1990-11-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


VAERS ID: 26713 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-10-02
Onset:1990-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (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 (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


VAERS ID: 26714 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1990-10-15
Onset:1990-10-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / UNK LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620D / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-21
   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: Tylenol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV mother put to bed at 10PM for the night. Found pt. at 5AM cold & stiff on 21OCT90.


VAERS ID: 26715 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1990-11-07
Onset:1990-11-10
   Days after vaccination:3
Submitted: 1990-11-20
   Days after onset:10
Entered: 1990-11-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256964 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 257190 / 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: 1990-11-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsey
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV SIDS presumed as of this date pending coronor''s report.


VAERS ID: 26721 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Iowa  
Vaccinated:1990-10-24
Onset:1990-11-02
   Days after vaccination:9
Submitted: 1990-11-14
   Days after onset:12
Entered: 1990-11-26
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC Split Type:

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


VAERS ID: 26799 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Jersey  
Vaccinated:1990-09-24
Onset:1990-09-26
   Days after vaccination:2
Submitted: 1990-11-20
   Days after onset:55
Entered: 1990-11-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281946 / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Hydronephrosis
SMQs:, Retroperitoneal fibrosis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV child died. Autopsy showed baby had one kidney with chronic type changes, damage, hydronephrosis.


VAERS ID: 26890 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Kansas  
Vaccinated:0000-00-00
Onset:1990-01-25
Submitted: 0000-00-00
Entered: 1990-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256930 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pneumonia, Sudden infant death syndrome
SMQs:, Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Post mortem - "slight pneumonia"
CDC Split Type:

Write-up: Pt vax with DTP/OPV was doing well on 25JAN90 taken to sitter. Found dead in crib in afternoon.


VAERS ID: 27000 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1989-08-15
Onset:1989-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 241916 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Cardiac arrest, Dyspnoea, Neuropathy, Paraesthesia, Pneumonia, Pneumothorax, Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy report dx: acute inflammatory polyneuropathy, interstitial pneumonitis, urinary tract infection, pneumothorax, cytomegalovirus infection, Epstein-Barr virus infection & cardiorespiratory arrest.
CDC Split Type: 890189201

Write-up: Pt vaccinated with TD c/o numbness of hand & feet 24-48 hrs after vaccination, decreased sensation in both feet (to pinprick), developed polyneuropathy & required mechanical ventilation, developed respiratory distress, suffered CR arrest.


VAERS ID: 26973 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: California  
Vaccinated:1990-07-17
Onset:1990-07-28
   Days after vaccination:11
Submitted: 1990-11-20
   Days after onset:115
Entered: 1990-12-12
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1990-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


VAERS ID: 26994 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-20
Onset:1990-11-22
   Days after vaccination:2
Submitted: 1990-12-06
   Days after onset:14
Entered: 1990-12-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277949 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA907

Write-up: Pt vaccinated with DTP/OPV child in bed w/parents - not breathing - taken to ER Indiana. Autopsy done - Dx SIDS


VAERS ID: 27141 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1990-10-22
Onset:1990-10-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-25
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


VAERS ID: 27153 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Unknown  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1990-12-05
Entered: 1990-12-21
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


VAERS ID: 27159 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted: 1990-12-17
Entered: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private       Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC Split Type:

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


VAERS ID: 27160 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:1990-12-18
Onset:1990-12-18
   Days after vaccination:0
Submitted: 1990-12-19
   Days after onset:1
Entered: 1990-12-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615A / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Caldesene cream
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/HIB expired 7 hrs later. Dx SIDS.


VAERS ID: 27161 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1990-12-11
Onset:1990-12-12
   Days after vaccination:1
Submitted: 1990-12-17
   Days after onset:5
Entered: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


VAERS ID: 27246 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1990-12-14
Onset:1990-12-15
   Days after vaccination:1
Submitted: 1990-12-17
   Days after onset:2
Entered: 1990-12-31
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


VAERS ID: 27275 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1990-11-26
Onset:1990-11-26
   Days after vaccination:0
Submitted: 1990-12-26
   Days after onset:30
Entered: 1991-01-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


VAERS ID: 27309 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: California  
Vaccinated:1990-12-06
Onset:1990-12-12
   Days after vaccination:6
Submitted: 1990-12-21
   Days after onset:9
Entered: 1991-01-04
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pathology report by Hosp.
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


VAERS ID: 27313 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: West Virginia  
Vaccinated:1989-07-17
Onset:1990-12-03
   Days after vaccination:504
Submitted: 1990-12-27
   Days after onset:24
Entered: 1991-01-07
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC Split Type: CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


VAERS ID: 27341 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1990-12-27
Onset:1990-12-29
   Days after vaccination:2
Submitted: 1991-01-03
   Days after onset:5
Entered: 1991-01-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


VAERS ID: 27451 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1990-11-20
Onset:1990-11-29
   Days after vaccination:9
Submitted: 1991-01-08
   Days after onset:40
Entered: 1991-01-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619L / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SIDS investigation & autopsy done
CDC Split Type:

Write-up: Dx sudden infant death syndrome died 29Nov90


VAERS ID: 27453 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Arizona  
Vaccinated:1990-08-14
Onset:1990-08-22
   Days after vaccination:8
Submitted: 1991-01-08
   Days after onset:139
Entered: 1991-01-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253948 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Coma, Dehydration, Diarrhoea, Hypotonia, Muscle atrophy, Pallor, Paralysis, Pyrexia, Renal failure, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1990-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Surgery Jul90 for incarcarated hernia.
Allergies:
Diagnostic Lab Data:
CDC Split Type: AZ9101

Write-up: 1 wk following DTP/OPV #2 developed explosive diarrhea & temp 106.1, pale, unresponsive, kidney failure. Dx severe blood infection/diarrhea & dehydration was on peritoneal dialysis. Also dx w/ Wernig Hoffman Disease.


VAERS ID: 27506 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Virginia  
Vaccinated:1991-01-08
Onset:1991-01-09
   Days after vaccination:1
Submitted: 1991-01-10
   Days after onset:1
Entered: 1991-01-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 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: 1991-01-09
   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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC Split Type: VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


VAERS ID: 27509 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Alaska  
Vaccinated:1991-01-14
Onset:1991-01-15
   Days after vaccination:1
Submitted: 1991-01-17
   Days after onset:2
Entered: 1991-01-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Received BPIG (IND drug) by Mass Biologic Labs, Lot #8, IM, RL, 1 prev dose at same time as HIB.
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: Received PRP-OMP & BPIG (IND drug) after being evaluated & found afeb. & in good health. Infant was found apneic in his bed the next AM.


VAERS ID: 27510 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1990-12-21
Onset:1990-12-22
   Days after vaccination:1
Submitted: 1991-01-16
   Days after onset:25
Entered: 1991-01-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FF / 1 RL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal distension, Apnoea, Brain oedema, Haemorrhage, Haemothorax, Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pedi-Care Decongestant Drops
Current Illness: Decongested
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given HIB titer 21DEC90 aprox 1230PM pt died 22DEC90 738 HRS.F/U 19Apr91 Autopsy rept-Acute respiratory failure,SIDS.Petechial hemorrhages of pleurae,epicardium & thymus.Pulmonary/cerebral edema &congestion.Congestion of abdo viscera.


VAERS ID: 27526 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Michigan  
Vaccinated:1990-12-22
Onset:1990-12-31
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Bronchitis, Cardiac failure, Coagulopathy, Convulsion, Infection, Pharyngitis, Pneumonia, Pyrexia, Rash, Renal failure, Sepsis, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? 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: WAES91010158

Write-up: Developed T,convuls&pneumonia.Hospitalized w/ septic shock, renal failure & disseminated intravascular coagulation.Develop rash&tracheitis.Culture-Staph aureus.Exp multiple system failure-renal/respiratory/metabolic/cardivascul.Died 11Jan91


VAERS ID: 27529 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1990-11-06
Onset:1990-11-07
   Days after vaccination:1
Submitted: 1991-01-18
   Days after onset:72
Entered: 1991-01-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-10
   Days after onset: 33
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: CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


VAERS ID: 27690 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:1991-01-18
Onset:1991-01-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC Split Type:

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


VAERS ID: 27691 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Minnesota  
Vaccinated:1991-01-17
Onset:1991-01-23
   Days after vaccination:6
Submitted: 1991-01-24
   Days after onset:1
Entered: 1991-02-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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: 1991-01-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC Split Type:

Write-up: Crib Death; Felt to be sids.


VAERS ID: 28070 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Dakota  
Vaccinated:1990-10-12
Onset:1990-10-15
   Days after vaccination:3
Submitted: 1991-01-10
   Days after onset:87
Entered: 1991-02-12
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 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: 1990-10-15
   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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC Split Type: SD91002

Write-up: SIDS.


VAERS ID: 28073 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arizona  
Vaccinated:1990-12-19
Onset:1990-12-22
   Days after vaccination:3
Submitted: 1990-12-26
   Days after onset:4
Entered: 1991-02-12
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 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: 1990-12-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC Split Type:

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


VAERS ID: 28546 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: D.C.  
Vaccinated:1990-05-24
Onset:1990-05-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8L01023 / UNK RA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Infection, Meningitis
SMQs:, 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC Split Type: CO3506

Write-up: Pt died; Meningococcal meningitis; Culture proven Neissera;


VAERS ID: 28091 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1990-10-09
Onset:1990-10-09
   Days after vaccination:0
Submitted: 1991-02-07
   Days after onset:121
Entered: 1991-02-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-14
   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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC Split Type:

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


VAERS ID: 28321 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-02-05
Onset:1991-02-06
   Days after vaccination:1
Submitted: 1991-02-07
   Days after onset:1
Entered: 1991-02-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 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: 1991-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tylenol poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC Split Type:

Write-up: sids death 16-24 hrs /p administration of imm.


VAERS ID: 28327 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Louisiana  
Vaccinated:1990-12-27
Onset:1991-01-02
   Days after vaccination:6
Submitted: 1991-01-15
   Days after onset:13
Entered: 1991-02-15
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287954 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Dehydration, Eye disorder, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-02
   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: Tylenol
Current Illness:
Preexisting Conditions: 26 wks preme, hx of hyaline membrane disease, sepsis, necrotizing enterocolitis /w small bowel resec, malabsorption, formula intolerance
Allergies:
Diagnostic Lab Data: CSF-clear, WBC-0, RBC-5, 0-Segs & Lymphs
CDC Split Type: LA910203

Write-up: Mom noted listlessness & dark circles around eyes in am 2Jan, pt taken Hosp arrived @ 11am, found to have T 103, T escalating, pt died @ 1130 am, cause of death - dehydration, No fever noted @ time of Immun. to arrival @ hosp, no neuro S+S


VAERS ID: 28357 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: California  
Vaccinated:1991-01-28
Onset:1991-01-31
   Days after vaccination:3
Submitted: 1991-02-13
   Days after onset:13
Entered: 1991-02-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Lung disorder, Petechiae, 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: 1991-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC Split Type:

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


VAERS ID: 28432 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1991-01-15
Onset:1991-01-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287942 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal distension, Apnoea, Cardiac arrest, Infection, Lung disorder, Personality disorder, Pulmonary oedema
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (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 encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no~ ()~~~In patient
Other Medications: synthroid
Current Illness: hypothyroidism, cranialsynostosis, herni
Preexisting Conditions: hypothyroidism, cranialsynostosis, hernia repair X 2, bronchopulmanary dysplasia
Allergies:
Diagnostic Lab Data: blood drawn post immun-all normal, blood drawn in ER possible for alpha strep
CDC Split Type: CT911

Write-up: pulmonary congestion & edema,bronchopulmonary dysplasia, Child not acting right all day, as per family, stopped breathing in front of mom, found in cardiac arrest by EMT who began CPR,pt found /w distended abdomen, decompressed manually


VAERS ID: 28514 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1989-12-14
Onset:1989-12-15
   Days after vaccination:1
Submitted: 1991-02-25
   Days after onset:437
Entered: 1991-03-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-23
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


VAERS ID: 28519 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Illinois  
Vaccinated:1990-11-29
Onset:1990-12-16
   Days after vaccination:17
Submitted: 1991-02-01
   Days after onset:47
Entered: 1991-03-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285949 / 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: 1990-12-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL913

Write-up: SIDS- 16DEC90.


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