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From the 9/17/2021 release of VAERS data:

Found 6,129 cases where Patient Died and Vaccination Date from '1991-01-01' to '2020-11-30'

Table

   
AgeCountPercent
< 3 Years3,45956.44%
3-6 Years951.55%
6-9 Years450.73%
9-12 Years540.88%
12-17 Years1302.12%
17-44 Years3205.22%
44-65 Years3756.12%
65-75 Years3696.02%
75+ Years68811.23%
Unknown5949.69%
TOTAL6,129100%



Case Details

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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: 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: 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: 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: 28528 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-02-18
Onset:1991-02-18
   Days after vaccination:0
Submitted: 1991-02-19
   Days after onset:1
Entered: 1991-03-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-18
   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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


VAERS ID: 28826 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-16
Onset:1991-02-09
   Days after vaccination:24
Submitted: 1991-02-15
   Days after onset:6
Entered: 1991-03-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 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: 1991-02-09
   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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR913

Write-up: SIDS.


VAERS ID: 28827 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Oregon  
Vaccinated:1991-02-07
Onset:1991-02-09
   Days after vaccination:2
Submitted: 1991-02-21
   Days after onset:12
Entered: 1991-03-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-10
   Days after onset: 1
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 report documented SIDS as cause of death
CDC Split Type: OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


VAERS ID: 28873 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1991-01-28
Onset:1991-01-30
   Days after vaccination:2
Submitted: 1991-02-12
   Days after onset:13
Entered: 1991-03-07
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


VAERS ID: 29133 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1991-02-11
Onset:1991-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP271 / 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: 1991-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had concommitent URI sx per mom 1-2 days prior to SIDS event.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 7 days after receiving 1st DTP immun.


VAERS ID: 29256 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1991-03-01
Onset:1991-03-02
   Days after vaccination:1
Submitted: 1991-03-05
   Days after onset:3
Entered: 1991-03-21
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 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: 1991-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC Split Type: 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


VAERS ID: 29272 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-30
Onset:1991-02-25
   Days after vaccination:26
Submitted: 1991-03-08
   Days after onset:11
Entered: 1991-03-22
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 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: 1991-02-25
   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: NONE
Current Illness: NONE
Preexisting Conditions: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS Death;


VAERS ID: 29345 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-28
Onset:1991-02-03
   Days after vaccination:6
Submitted: 1991-02-16
   Days after onset:13
Entered: 1991-03-25
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 289945 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91529

Write-up: Crib Death- SIDS;


VAERS ID: 29348 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-03-08
Onset:1991-03-10
   Days after vaccination:2
Submitted: 1991-03-21
   Days after onset:11
Entered: 1991-03-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-03-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC Split Type:

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


VAERS ID: 29397 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-02-27
Onset:1991-02-28
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:8
Entered: 1991-03-27
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M2053P / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: None apparent
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Bloodwork & Urinalysis - normal
CDC Split Type: PA9186

Write-up: Fever to 104 27FEB91 & 105 28FEB91; To ER 28FEB91; No apparent infect; Had red blotching on face 1MAR91 p/taking Augmentin was discontinued due to poss allergy; continues to have low grade fever & has clear nasal discharge.


VAERS ID: 29431 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1991-03-15
Onset:1991-03-21
   Days after vaccination:6
Submitted: 1991-03-22
   Days after onset:1
Entered: 1991-03-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FP / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295948 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: prior 2-3 wks bronchitis-now over
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy -SIDS
CDC Split Type:

Write-up: Sudden arrest /p feeding @ baby sitters. DOA 6 days /p vaxs. Baby was fine before, mother went to work. With baby sitter. Autopsy prelim DX-SIDS death, no abnormalities found


VAERS ID: 29463 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-17
Onset:1991-01-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-02
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


VAERS ID: 29477 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1991-02-21
Onset:1991-02-21
   Days after vaccination:0
Submitted: 1991-03-08
   Days after onset:15
Entered: 1991-04-01
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Hypotonia, Injection site pain, Pallor, Pyrexia, Sudden infant death syndrome
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Neonatal disorders (narrow), 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: 1991-02-26
   Days after onset: 5
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: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: possible sids autospy report pending
CDC Split Type: TX9122

Write-up: Child mild fever & pain @ inject site; woke up crying; Limp & pale mom not certain if baby was breathing resuscitated poss SIDS;


VAERS ID: 29485 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-25
Onset:1991-02-16
   Days after vaccination:22
Submitted: 1991-03-21
   Days after onset:33
Entered: 1991-04-01
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283970 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91532

Write-up: SIDS


VAERS ID: 29488 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-03-25
Onset:1991-03-26
   Days after vaccination:1
Submitted: 1991-03-29
   Days after onset:3
Entered: 1991-04-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21000 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac Arrest noted 26MAR @ approx 7PM; Brought to ER-Resuscitation efforts did not help;


VAERS ID: 29754 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-01-22
Onset:0000-00-00
Submitted: 1991-02-05
Entered: 1991-04-05
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 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: 1991-01-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91012

Write-up: infant death-pending autopsy


VAERS ID: 29756 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-01-08
Onset:0000-00-00
Submitted: 1991-02-11
Entered: 1991-04-05
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91014

Write-up:


VAERS ID: 29769 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: South Carolina  
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted: 1991-03-25
Entered: 1991-04-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-23
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: SC91032

Write-up:


VAERS ID: 29812 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Texas  
Vaccinated:1991-03-06
Onset:1991-03-08
   Days after vaccination:2
Submitted: 1991-03-11
   Days after onset:3
Entered: 1991-04-08
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


VAERS ID: 29848 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-01-24
Onset:1991-02-19
   Days after vaccination:26
Submitted: 1991-04-06
   Days after onset:46
Entered: 1991-04-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 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: 1991-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none in pt or siblings~ ()~~~In patient
Other Medications: Naldec
Current Illness: nasal congestion
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: none
CDC Split Type: SD91009

Write-up: SIDS


VAERS ID: 29892 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Maryland  
Vaccinated:1991-03-19
Onset:1991-03-22
   Days after vaccination:3
Submitted: 1991-04-09
   Days after onset:17
Entered: 1991-04-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis, Rhinitis, Sepsis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: VSD, Pulmonary artery stenosis;
Preexisting Conditions: premature, BW 3 13; 10 day of tx 2 birth for poss Sepsis stayed in Hosp 30 days- 1 day in oxygen;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt fine for 3 day; on 22MAR91 sleeping - sitter checked her & found her w/vomitus around her mouth & blue; Mom says she has runny nose the night prior to event; CPR was given there & in ambulance & ER but w/o result;


VAERS ID: 29967 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1991-03-21
Onset:1991-03-22
   Days after vaccination:1
Submitted: 1991-03-22
   Days after onset:0
Entered: 1991-04-19
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Congenital arterial malformation, Face oedema, Heart disease congenital
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Congenital, familial and genetic disorders (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-22
   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: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


VAERS ID: 29978 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-02-14
Onset:1991-03-10
   Days after vaccination:24
Submitted: 1991-04-16
   Days after onset:36
Entered: 1991-04-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rhinitis, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-10
   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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC Split Type:

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


VAERS ID: 29990 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-01-28
Onset:1991-01-30
   Days after vaccination:2
Submitted: 1991-04-02
   Days after onset:62
Entered: 1991-04-19
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283912 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH MC507B / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625A / 1 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: 1991-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 910071301

Write-up: 2mos pt recvd DTP/OPV/Hibtiter on 28Jan91. Found in crib on 30Jan91-unable to resuscitate.No intervening illness.Preliminary autopsy report, no pathology, probable SIDS


VAERS ID: 30005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-03-26
Onset:1991-03-27
   Days after vaccination:1
Submitted: 1991-03-27
   Days after onset:0
Entered: 1991-04-22
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622M / 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: 1991-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Rondec DM drops
Current Illness: mild stuffy nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC91024

Write-up: Reported crib death;


VAERS ID: 30020 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Kentucky  
Vaccinated:1991-01-14
Onset:0000-00-00
Submitted: 1991-02-07
Entered: 1991-04-22
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281929 / 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: 1991-01-18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY918

Write-up: Reported - SIDS


VAERS ID: 30023 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Kentucky  
Vaccinated:1991-01-15
Onset:1991-02-13
   Days after vaccination:29
Submitted: 1991-02-19
   Days after onset:6
Entered: 1991-04-22
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618F / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Stupor
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY9111

Write-up: Child was found non responsive & with apnea 13FEB91 was taken the ER w/o successful resuscitation;


VAERS ID: 30143 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-02-27
Onset:1991-03-03
   Days after vaccination:4
Submitted: 1991-03-08
   Days after onset:5
Entered: 1991-04-26
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291947 / 1 MO / PO

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: 1991-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Infant had an ear infect 2 wks prior vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9153

Write-up: Autopsy performed, cause of death determined to be sudden infant death synd;


VAERS ID: 30208 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1991-03-20
Onset:1991-03-27
   Days after vaccination:7
Submitted: 1991-04-12
   Days after onset:15
Entered: 1991-04-29
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-27
   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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


VAERS ID: 30232 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: Montana  
Vaccinated:1991-02-21
Onset:1991-02-24
   Days after vaccination:3
Submitted: 1991-04-25
   Days after onset:59
Entered: 1991-04-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / 3 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac failure, Delirium
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Ammonia 711
CDC Split Type:

Write-up: Death from Reyes synd on 24FEB91 & presented to ER in full arrest & was not resuscitative;


VAERS ID: 30241 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-04-02
Onset:1991-04-04
   Days after vaccination:2
Submitted: 1991-04-04
   Days after onset:0
Entered: 1991-04-29
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 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: 1991-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC Split Type: CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


VAERS ID: 30365 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-02-26
Onset:1991-03-06
   Days after vaccination:8
Submitted: 1991-03-07
   Days after onset:1
Entered: 1991-05-10
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625B / 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: 1991-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy ordered
CDC Split Type: TN9172

Write-up: Found dead;


VAERS ID: 30386 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-05-02
Onset:1991-05-05
   Days after vaccination:3
Submitted: 1991-05-06
   Days after onset:1
Entered: 1991-05-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Healthy infant found dead in crib by parents


VAERS ID: 30428 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:1991-01-28
Onset:1991-01-29
   Days after vaccination:1
Submitted: 1991-01-30
   Days after onset:1
Entered: 1991-05-13
   Days after submission:102
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


VAERS ID: 30429 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-03-12
Onset:1991-03-13
   Days after vaccination:1
Submitted: 1991-04-18
   Days after onset:35
Entered: 1991-05-13
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


VAERS ID: 30450 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-04-23
Onset:1991-04-24
   Days after vaccination:1
Submitted: 1991-04-26
   Days after onset:2
Entered: 1991-05-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0268B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910090301

Write-up: 2mo infant rec''d DTP/OPV/HIBTITER on 23APR91; Found dead at the babysitter''s 24APR91;


VAERS ID: 30604 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted: 1991-05-09
Entered: 1991-05-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 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: 1991-04-08
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: NA
CDC Split Type:

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


VAERS ID: 30620 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: Nebraska  
Vaccinated:1991-03-14
Onset:1991-03-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1991-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 5 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626H / 5 - / -

Administered by: Public       Purchased by: Public
Symptoms: Diabetes mellitus, Ketosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-31
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NE918

Write-up: Death dx - diabetic ketoacidosis;


VAERS ID: 30667 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1991-05-03
Onset:1991-05-07
   Days after vaccination:4
Submitted: 1991-05-14
   Days after onset:7
Entered: 1991-05-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: pt was finishing course of Ceclor
Current Illness: resolving otitis media
Preexisting Conditions: rt hydrocele
Allergies:
Diagnostic Lab Data: Autopsy done 7May91.Provisional Anatomic Diagnoses:Consistent /w SIDS
CDC Split Type:

Write-up: Pt recvd immun on 3May91,@time of 4mo well baby checkup.Pt was seen in ER on 7May91 @ 630am in cardiac & respiratory arrest as an apparent SIDS death & pronounced dead /p CPR attempts.


VAERS ID: 30808 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-05-08
Onset:1991-05-10
   Days after vaccination:2
Submitted: 1991-05-17
   Days after onset:7
Entered: 1991-05-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M1204A / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297957 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Diarrhoea, Polyuria
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Intolerant to CM & Soy formulas x/soyalac
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt rec''d initial DPT/OPV/HIB developed fretful later the same day, rec''d APAP; Stools seemed loose; child voided more than usual; But looked OK next day, died unexpectedly in sleep;


VAERS ID: 30812 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted: 1991-05-17
Entered: 1991-05-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 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: 1991-03-14
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: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC Split Type: SC91056

Write-up: Pt died on 14MAR91;


VAERS ID: 30822 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Ohio  
Vaccinated:1991-03-26
Onset:1991-04-01
   Days after vaccination:6
Submitted: 1991-04-19
   Days after onset:17
Entered: 1991-05-24
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295943 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910085101

Write-up: 5mo child rec''d shot''s 26MAR91; child died on 1APR91; Coroner''s report was SIDS; child had tracheal malacia & had been sick so this was first DTP; Second OPV;


VAERS ID: 30833 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-01-04
Onset:0000-00-00
Submitted: 1991-04-22
Entered: 1991-05-24
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279936 / 1 MO / PO

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: 1991-01-28
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: slow weight gain
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA910503

Write-up: SIDS; Death 28JAN91;


VAERS ID: 30844 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: South Dakota  
Vaccinated:1991-04-03
Onset:1991-04-08
   Days after vaccination:5
Submitted: 1991-05-14
   Days after onset:36
Entered: 1991-05-24
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 614E1 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Brother reacted to DTP in 1988;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report attached
CDC Split Type: SD91015

Write-up: Child was admitted to Hosp on 9MAR91 by MD for resp problems (apnea); D/C 13MAR91 & was fine;


VAERS ID: 30887 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-04-22
Onset:1991-05-11
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 1991-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295955 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-11
   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: No other drugs noted
Current Illness:
Preexisting Conditions: prior sib died of myocarditis
Allergies:
Diagnostic Lab Data: Preliminary post mortem reort viral pneumonia
CDC Split Type:

Write-up: Infant rec''d DTP/OPV on 22APR91 no adverse rxn noted; In next 48hrs-infant went to slep 11MAY91 & appeared well; found dead in bed p/nap;


VAERS ID: 30928 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1991-04-22
Onset:1991-04-23
   Days after vaccination:1
Submitted: 1991-04-24
   Days after onset:1
Entered: 1991-06-03
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914I / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295932 / 1 MO / PO

Administered by: Public       Purchased by: Public
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: 1991-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Postmortem Autopsy
CDC Split Type: OR9115

Write-up: Infant given DTP/HIB/OPV; sl elv fever & irritability that PM, then infant died in sleep during nap the next day; (SIDS); 0 sz or other activity noted;


VAERS ID: 31289 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1991-05-31
Onset:1991-06-03
   Days after vaccination:3
Submitted: 1991-06-08
   Days after onset:5
Entered: 1991-06-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 629B / 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: 1991-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt died of SIDS 3 days following administration of vax;


VAERS ID: 31355 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1991-03-06
Onset:1991-03-09
   Days after vaccination:3
Submitted: 1991-03-28
   Days after onset:19
Entered: 1991-06-17
   Days after submission:80
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FM / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 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: 1991-03-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: GA91134

Write-up: SIDS;


VAERS ID: 31356 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:1991-04-04
Onset:1991-04-09
   Days after vaccination:5
Submitted: 1991-05-28
   Days after onset:49
Entered: 1991-06-17
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295971 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624C / 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: 1991-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: poor wt gain w/breast feeding
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: GA91135

Write-up: SIDS;


VAERS ID: 31377 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:1991-06-06
Onset:1991-06-07
   Days after vaccination:1
Submitted: 1991-06-12
   Days after onset:5
Entered: 1991-06-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293949 / 2 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 2 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 293938 / 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: 1991-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: well growing baby
CDC Split Type:

Write-up: Pt @ 4 mo of age on 6Jun91 recvd DPT/OPV/HIBV.There were no reported fever, anaphylaxis, sz but pt died of SIDS on 7Jun91 evening.Found dead in basinet by mom


VAERS ID: 31378 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Jersey  
Vaccinated:1991-03-13
Onset:1991-03-22
   Days after vaccination:9
Submitted: 1991-06-10
   Days after onset:79
Entered: 1991-06-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-22
   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: atopic dermatitis
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: R/O sudden infant death synd.Autopsy performed
CDC Split Type:

Write-up: Recvd Hib titer vax 13Mar91. On 22Mar91 the pt was brought to ER. Dead on arrival


VAERS ID: 31415 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Alaska  
Vaccinated:1991-02-28
Onset:1991-03-28
   Days after vaccination:28
Submitted: 1991-06-13
   Days after onset:76
Entered: 1991-06-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-26
   Days after onset: 58
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC Split Type: WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


VAERS ID: 31738 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Alaska  
Vaccinated:1991-02-25
Onset:1991-03-06
   Days after vaccination:9
Submitted: 1991-06-20
   Days after onset:105
Entered: 1991-06-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Bradycardia, CSF test abnormal, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-10
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC Split Type: WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


VAERS ID: 32264 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kansas  
Vaccinated:1991-04-04
Onset:1991-04-29
   Days after vaccination:25
Submitted: 1991-05-03
   Days after onset:4
Entered: 1991-07-08
   Days after submission:66
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M565FP / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 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: 1991-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: KS9126

Write-up: NONE KNOWN; Autopsy dx of SIDS;


VAERS ID: 32297 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-04-25
Onset:1991-04-27
   Days after vaccination:2
Submitted: 1991-05-08
   Days after onset:11
Entered: 1991-07-08
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiomegaly, Cerebral ischaemia, Hepatosplenomegaly, Infection, Myocarditis, Pneumonia, Screaming, Supraventricular tachycardia
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 3MAR91 dx viral synd; 12MAR91 resolved viral synd; nasal congestion;
Allergies:
Diagnostic Lab Data: Autopsy by Hosp
CDC Split Type: TN9194

Write-up: Pt was irritable & cried & cried all day; Ambulance called but not taken to Hosp; Later seen in ER & died; MD states death had to do w/chambers of the heart & mixing of blood Death certificate states cardiac failure;


VAERS ID: 32527 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-04-24
Onset:1991-04-25
   Days after vaccination:1
Submitted: 1991-04-26
   Days after onset:1
Entered: 1991-07-12
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300922 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295932 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Hypertonia
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-25
   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: Pt given DTP/OVP 14FEB91;
Current Illness: NONE
Preexisting Conditions: pneumonia 26MAR, Rx EES x 10d (recovered)
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: PA91186

Write-up: Parents fed infant @ 430AM, put back to bed; Went in between 5-6AM, found Pt face down, stiff- called 911 prononuced dead @ 851AM;


VAERS ID: 32592 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-06-27
Onset:1991-07-08
   Days after vaccination:11
Submitted: 1991-07-10
   Days after onset:2
Entered: 1991-07-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304919 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 632C5 / 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: 1991-07-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gross = SIDS; Coroner report pending
CDC Split Type:

Write-up: Apparent SIDS 8JUL91;


VAERS ID: 32649 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Indiana  
Vaccinated:1991-04-16
Onset:1991-04-18
   Days after vaccination:2
Submitted: 1991-05-01
   Days after onset:13
Entered: 1991-07-18
   Days after submission:78
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M565SP / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297945 / 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: 1991-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: pending
CDC Split Type: IN9118

Write-up: Pt appeared normal & hlthy. Put down for nap, found dead later. DX: SIDS by medical examiner


VAERS ID: 32678 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-03-05
Onset:1991-04-01
   Days after vaccination:27
Submitted: 1991-07-01
   Days after onset:90
Entered: 1991-07-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291947 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS death 1APR91;


VAERS ID: 32774 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1991-03-06
Onset:1991-03-07
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:1
Entered: 1991-07-22
   Days after submission:135
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M60FC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 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: 1991-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt was premature delivery at 31.5; corrected 35 wk gest; hip click & small umbical hernia;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA9178

Write-up: Pt recvd vax 6MAR91 next day put to bed around 10AM & returned to room to check on between 1130-12pm pt was not responsive; Taken to Hosp ER; pathologic dx SIDS;


VAERS ID: 32819 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: South Dakota  
Vaccinated:1991-02-04
Onset:1991-02-07
   Days after vaccination:3
Submitted: 1991-07-15
   Days after onset:157
Entered: 1991-07-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 293950 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291976 / 2 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: 1991-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: SD91022

Write-up: SIDS;


VAERS ID: 32875 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Male  
Location: Kansas  
Vaccinated:1991-04-05
Onset:1991-04-06
   Days after vaccination:1
Submitted: 1991-07-11
   Days after onset:95
Entered: 1991-07-25
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 4 - / IM L

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-08
   Days after onset: 1
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: strep pneumo Sepsis
CDC Split Type: KS9145

Write-up: Pt devel temp 1 day post vax persisted for 2 days; Admitted for Sepsis & expired the same day;


VAERS ID: 33131 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Virginia  
Vaccinated:1991-07-08
Onset:1991-07-20
   Days after vaccination:12
Submitted: 1991-07-23
   Days after onset:3
Entered: 1991-08-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300923 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304958 / 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: 1991-07-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type: VA91062

Write-up: Autopsy showed cause of death natural; found in crib;


VAERS ID: 33132 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-04-15
Onset:1991-05-04
   Days after vaccination:19
Submitted: 1991-06-14
   Days after onset:41
Entered: 1991-08-01
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297957 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-07
   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: Multi-vits w/flouride
Current Illness: NONE
Preexisting Conditions: Hemangioma lt lower eyelid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden infant death syndrome;


VAERS ID: 33434 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-07-18
Onset:1991-07-24
   Days after vaccination:6
Submitted: 1991-07-25
   Days after onset:1
Entered: 1991-08-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300922 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 300949 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-24
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE-hx of congenital rx MAY91
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA91248

Write-up: Mom fed pt approx 530AM; Returned to check on pt 11AM; Pt unresponsive; Called EMS; 24JUL91 DOA 1130-12PM; SIDS?


VAERS ID: 33574 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1991-07-23
Onset:1991-07-25
   Days after vaccination:2
Submitted: 1991-08-01
   Days after onset:7
Entered: 1991-08-12
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0633C / 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: 1991-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy requested
CDC Split Type: OR9134

Write-up: Pt immun 23JUL91 & had SIDS on 25JUL91;


VAERS ID: 33906 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1991-07-23
Onset:1991-08-01
   Days after vaccination:9
Submitted: 1991-08-07
   Days after onset:6
Entered: 1991-08-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21001 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302941 / 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: 1991-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Dislocated hips-bilateral
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 1AUG91;


VAERS ID: 33907 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1991-08-02
Onset:1991-08-08
   Days after vaccination:6
Submitted: 1991-08-15
   Days after onset:7
Entered: 1991-08-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297907 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 300941 / 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: 1991-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt found dead in bed-SIDS;


VAERS ID: 34077 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-08-01
Onset:1991-08-07
   Days after vaccination:6
Submitted: 1991-08-15
   Days after onset:8
Entered: 1991-08-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH A2200 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laryngitis, Pallor, Petechiae, Splenomegaly, Stupor, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (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: 1991-08-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 6 days p/vax, pt found in crib in AM unresponsive & ashen; To ER; complete arrest;


VAERS ID: 34139 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1991-08-08
Onset:1991-08-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1991-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21031 / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HE / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 638K / 1 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-08-11
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: umbilical hernia
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3924

Write-up: Probable SIDS; died 72 hrs post-vax;


VAERS ID: 34373 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:1991-04-17
Onset:1991-04-20
   Days after vaccination:3
Submitted: 1991-04-22
   Days after onset:2
Entered: 1991-08-29
   Days after submission:129
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-21
   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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC Split Type: NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


VAERS ID: 34471 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Female  
Location: Georgia  
Vaccinated:1991-08-13
Onset:1991-08-14
   Days after vaccination:1
Submitted: 1991-08-23
   Days after onset:9
Entered: 1991-09-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Acidosis, Convulsion, Haemorrhage, Marrow hyperplasia, Necrosis, Petechiae, Splenomegaly, Thrombotic thrombocytopenic purpura
SMQs:, Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Renovascular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: few petechia on back, abd, legs
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91239

Write-up: Mom called 19AUG91 reporting pt started w/diarrhea, fever? (no thermometer), sleeping a lot on 14AUG91; rash on 18AUG91 & was advised to seek med eval that day; Did not go for care until pt collapsed @ home p/MN; Taken to ER, where pt died;


VAERS ID: 34472 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Georgia  
Vaccinated:1991-04-16
Onset:1991-04-18
   Days after vaccination:2
Submitted: 1991-04-19
   Days after onset:1
Entered: 1991-09-03
   Days after submission:137
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281947 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-19
   Days after onset: 1
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 report
CDC Split Type: GA91240

Write-up: No sx until 18APR91; pt became a little fussy, no fever; pt settled down by bedtime & mom thought pt was sleeping; Mom found pt dead AM of 19APR91;


VAERS ID: 34482 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-07-31
Onset:1991-08-01
   Days after vaccination:1
Submitted: 1991-08-02
   Days after onset:1
Entered: 1991-09-03
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 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: 1991-08-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-medical examiner 2AUG91
CDC Split Type: NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


VAERS ID: 34563 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted: 1991-08-29
Entered: 1991-09-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 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: 1991-08-06
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Not known; SIDS


VAERS ID: 34628 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-04-19
Onset:1991-04-20
   Days after vaccination:1
Submitted: 1991-07-15
   Days after onset:86
Entered: 1991-09-10
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21000 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297950 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Bradycardia, 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: 1991-05-14
   Days after onset: 24
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: Caffeine, Polyvisol
Current Illness: NONE
Preexisting Conditions: prematurity, obstructive apnea
Allergies:
Diagnostic Lab Data: See admission H & P
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB evening 19APR91 & returned to office w/profound apnea & bradycardia requiring mechanical ventilation 20APR91 @ 930AM; Pt expired 14MAY91 of cardio-respiratory arrest p/transfer there on 20APR91;


VAERS ID: 34926 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Virginia  
Vaccinated:1991-08-14
Onset:1991-08-17
   Days after vaccination:3
Submitted: 1991-09-10
   Days after onset:24
Entered: 1991-09-23
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 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: 1991-08-17
   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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC Split Type: VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


VAERS ID: 35080 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1991-08-30
Onset:1991-08-30
   Days after vaccination:0
Submitted: 1991-09-06
   Days after onset:7
Entered: 1991-09-30
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306965 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Instructed to use none; APAP if needed;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WA91618

Write-up: Pt died-SIDS on death certificate; Pt died evening p/immun were given; MD requested vax adverse rxn report be filed; Mom states pt did not seem to have had any reactions to the immun;


VAERS ID: 35089 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-06-17
Onset:1991-07-07
   Days after vaccination:20
Submitted: 1991-09-24
   Days after onset:79
Entered: 1991-09-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private       Purchased by: Public
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: 1991-07-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC Split Type:

Write-up: spitting up day before death, no diarrhea, fever;


VAERS ID: 35466 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-09-13
Onset:1991-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-14
   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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT found dead in his crib;


VAERS ID: 35477 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-26
Onset:1991-09-26
   Days after vaccination:0
Submitted: 1991-09-30
   Days after onset:4
Entered: 1991-10-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC Split Type: LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


VAERS ID: 35493 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1991-10-02
Onset:1991-10-02
   Days after vaccination:0
Submitted: 1991-10-08
   Days after onset:6
Entered: 1991-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1214 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0636B / 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: 1991-10-04
   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: NONE
Current Illness: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: Death from apparent SIDS; sudden infant Death Syndrome;


VAERS ID: 35495 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New York  
Vaccinated:1991-09-25
Onset:1991-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence
SMQs:, Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-09-29
   Days after onset: 3
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: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC Split Type:

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


VAERS ID: 35663 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-10
Onset:1991-09-20
   Days after vaccination:10
Submitted: 1991-09-24
   Days after onset:4
Entered: 1991-10-21
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-21
   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: H. Influenza meningitis;
CDC Split Type: LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


VAERS ID: 35692 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1991-09-17
Onset:1991-09-19
   Days after vaccination:2
Submitted: 1991-10-12
   Days after onset:23
Entered: 1991-10-21
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 1D21000 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 623K4 / 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: 1991-09-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No sx in 1st 24 hrs p/immun; pt found dead in crib on morning of 19SEP91 approx 48hrs p/vax; SIDS dx p/exam in ER @ Hosp & autopsy;


VAERS ID: 35727 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Colorado  
Vaccinated:1991-07-16
Onset:1991-07-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1991-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300921 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165FH / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0631D / 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:

Write-up: Pt had 4mo vax & 4 days a/being brought in DOA w/probable SIDS; MD didn''t feel this was a rxn to the vax but thought it should be reported;


VAERS ID: 35975 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1991-10-14
Onset:1991-10-15
   Days after vaccination:1
Submitted: 1991-10-16
   Days after onset:1
Entered: 1991-11-04
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304920 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0629A / 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: 1991-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNKNOWN
Current Illness: Well baby;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910194901

Write-up: 2 mo well infant recd 1st DTP/HibTITER/OPV on 14OCT91; 14 hours p/vax, pt died 15OCT91; cause of death diagnosed as SIDS;


VAERS ID: 35987 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-09-04
Onset:0000-00-00
Submitted: 1991-10-10
Entered: 1991-11-04
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120HA / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-27
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: SC91162

Write-up:


VAERS ID: 36008 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-09-12
Onset:1991-10-07
   Days after vaccination:25
Submitted: 1991-10-11
   Days after onset:4
Entered: 1991-11-04
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306925 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0639H / 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: 1991-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 32 wk SGA-apnea ofprematurity-resolved; coag-staph; UTI-resolved;
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN91193

Write-up: DTP/OPV/HIB #1 given 12SEP91-clinically well @ time; pt DOA @ Hosp 7OCT91; unresponsive to resuscitative efforts;


VAERS ID: 36133 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Utah  
Vaccinated:1991-10-11
Onset:1991-10-11
   Days after vaccination:0
Submitted: 1991-10-28
   Days after onset:17
Entered: 1991-11-07
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K21074 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HE / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-13
   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: multiplebirth defects,tracheostomy on respirator @ home;
Allergies:
Diagnostic Lab Data: autopsy was non-revealing of cause;
CDC Split Type: CO3993

Write-up: Arrested 1 1/2 hrs post inject; resuscitated & put on respirator; 24 hrs later MD discusssed w/parents about d/c life support because pt multiple problems & was non-responsive to current tx; Life support systems d/c pt allowed to die;


VAERS ID: 36170 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1991-02-22
Onset:1991-02-26
   Days after vaccination:4
Submitted: 1991-03-11
   Days after onset:13
Entered: 1991-11-08
   Days after submission:242
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608L / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Petechiae, Pyrexia, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 34 wks gestation @ delivery
Allergies:
Diagnostic Lab Data: Autopsy was performed but will be 2-3 months a/gets reports; Death cert had SIDS as cause of death;
CDC Split Type: GA91300

Write-up: Mom reports pt had slight fever the evening p/the immun 22FEB91 but no other adverse signs;


VAERS ID: 36314 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Georgia  
Vaccinated:1991-10-15
Onset:1991-10-16
   Days after vaccination:1
Submitted: 1991-10-30
   Days after onset:14
Entered: 1991-11-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K21074 / 4 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0638L / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: transfusion dependent anemia, spasticity, extreme failure to thrive
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: Pt found the next morning asystolic full resuscitation attempted;


VAERS ID: 36455 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Texas  
Vaccinated:1991-10-24
Onset:1991-10-26
   Days after vaccination:2
Submitted: 1991-11-12
   Days after onset:17
Entered: 1991-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


VAERS ID: 36536 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Maryland  
Vaccinated:1991-06-25
Onset:1991-07-04
   Days after vaccination:9
Submitted: 1991-11-18
   Days after onset:137
Entered: 1991-11-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Atelectasis, Pneumothorax, Respiratory disorder
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: OM
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: xray showed total lung atelectasis, ipsilateral retraction of the mediastinum, pneumothorax & pneumomediastinum;
CDC Split Type: WAES91110463

Write-up: Pt recvd 1st & 2nd dose of vax & later booster dose HIB vax; On 4JUL91 pt found not breathing; rescusitation was unsuccessful; during intubation, formula noted in trachea;


VAERS ID: 36623 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-07
Onset:1991-10-20
   Days after vaccination:13
Submitted: 1991-11-07
   Days after onset:18
Entered: 1991-11-25
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hyperglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC Split Type: SD91025

Write-up: 20OCT91 pt expired;


VAERS ID: 36624 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-08
Onset:1991-10-09
   Days after vaccination:1
Submitted: 1991-10-28
   Days after onset:19
Entered: 1991-11-25
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Diarrhoea, Nausea, Right ventricular failure, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-14
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ
Current Illness: NONE
Preexisting Conditions: arthritis, hypertension
Allergies:
Diagnostic Lab Data: total bilirubin results inconclusive;
CDC Split Type: SD91026

Write-up: Nausea, vomiting, diarrhea started 9OCT or 10OCT, diarrhea stopped but was still nauseated; MD ordered Phenergan supp 13OCT91; congestive heart failure was reason for death;


VAERS ID: 36644 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:1991-09-23
Onset:1991-09-25
   Days after vaccination:2
Submitted: 1991-10-01
   Days after onset:6
Entered: 1991-11-26
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 0127P / 3 LA / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Hypoxia, Malaise, Respiratory disorder, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gastroenteritis
Preexisting Conditions: moderate to marked atherosclerosis, coronary artery
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91311

Write-up: Pt became ill 2 days following inject; admitted to hosp because of dehydration; died 28SEP91; death certificate-ventricular fibrillation, hypoxia, aspiration, gastric contents;


VAERS ID: 36725 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Ohio  
Vaccinated:1991-11-20
Onset:1991-11-22
   Days after vaccination:2
Submitted: 1991-11-25
   Days after onset:3
Entered: 1991-12-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300921 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310957 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd vax 20NOV91 & had no sx until 22NOV91 when pt was placed for nap @ 12PM checked 30 min & found to have no respirations or heart rate; CPR administered but was unsuccessful;


VAERS ID: 36736 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:1991-11-11
Onset:1991-11-12
   Days after vaccination:1
Submitted: 1991-11-25
   Days after onset:13
Entered: 1991-12-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown       Purchased by: Private
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC Split Type:

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


VAERS ID: 37777 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New York  
Vaccinated:1991-07-08
Onset:1991-11-04
   Days after vaccination:119
Submitted: 1991-12-02
   Days after onset:28
Entered: 1991-12-04
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1581S / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Ascites, Coagulopathy, Coma, Hepatic failure, Hepatic necrosis, Hepatitis, Infection, Intracranial pressure increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness:
Preexisting Conditions: Mom HBAg positive;
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91110702

Write-up: Pt recvd 2nd dose of Hep B vax @ one month of age; subsequently, pt devel fulminant Hep B & was hospitalized for a liver transplant; In mid-November 91, pt died @ 5 months of age;


VAERS ID: 37800 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Iowa  
Vaccinated:1991-08-27
Onset:1991-09-03
   Days after vaccination:7
Submitted: 1991-11-26
   Days after onset:84
Entered: 1991-12-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Confusional state, Convulsion, Headache, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-04
   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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC Split Type: IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


VAERS ID: 37801 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Indiana  
Vaccinated:1991-10-24
Onset:1991-11-02
   Days after vaccination:9
Submitted: 1991-12-03
   Days after onset:31
Entered: 1991-12-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1M11009 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125HF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0635E / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Pneumonia
SMQs:, Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-11-02
   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: cold sz w/o fever
Preexisting Conditions: mild upper resp infect @ MD''s office 21OCT91
Allergies:
Diagnostic Lab Data: Autopsy performed-pneumonia was cause of death;
CDC Split Type: IN9132

Write-up: Pt found face down & not breathing on 2NOV91 AM; an ambulance was called but the pt could not be revived;


VAERS ID: 37817 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1991-11-18
Onset:1991-11-18
   Days after vaccination:0
Submitted: 1991-11-19
   Days after onset:1
Entered: 1991-12-09
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-11-18
   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: UNK
Current Illness: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


VAERS ID: 37837 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1991-07-12
Onset:1991-07-30
   Days after vaccination:18
Submitted: 1991-12-05
   Days after onset:128
Entered: 1991-12-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC Split Type:

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


VAERS ID: 37838 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arizona  
Vaccinated:1991-10-23
Onset:1991-11-01
   Days after vaccination:9
Submitted: 1991-11-28
   Days after onset:27
Entered: 1991-12-09
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / 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: 1991-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Brother SIDS @ 3mos w/DTP/OPV~ ()~~~In Sibling
Other Medications: Pt also recvd OPV
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Died of SIDS 8 days p/immun;


VAERS ID: 37846 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Arizona  
Vaccinated:1991-10-18
Onset:1991-11-14
   Days after vaccination:27
Submitted: 1991-12-03
   Days after onset:19
Entered: 1991-12-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procardia, Ascriptin
Current Illness: NONE
Preexisting Conditions: previous hx brainstomy tia w/flaccid FEB91
Allergies:
Diagnostic Lab Data: MRI Scan-neg; LP-normal; NCV loss of F waves, slowing;
CDC Split Type:

Write-up: 3 wks post inject pt devel paralysis;


VAERS ID: 37877 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1991-10-25
Onset:1991-11-20
   Days after vaccination:26
Submitted: 1991-12-03
   Days after onset:13
Entered: 1991-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01071P / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Anorexia, Intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Aldactone, Edecrin, Premarin, Prednisone, Ativan
Current Illness: NONE
Preexisting Conditions: Alzheimer''s dementia, CHF, hypertension, chronic lymphedeme
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV9158

Write-up: 20NOV91 began vomiting @ 130AM x 2 refused to eat through the day; no audible bowel sounds @ 715PM & c/o abd tenderness & admitted to Hosp 20NOV; bowel resection completed due to volvolus of bowel;


VAERS ID: 38150 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1991-12-04
Onset:1991-12-04
   Days after vaccination:0
Submitted: 1991-12-20
   Days after onset:16
Entered: 1991-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


VAERS ID: 38163 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:1991-11-06
Onset:1991-11-08
   Days after vaccination:2
Submitted: 1991-11-15
   Days after onset:7
Entered: 1991-12-30
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
   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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


VAERS ID: 38173 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:1991-11-25
Onset:1991-11-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HH / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643H / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: SIDS; gross autopsy report consistent w/dx of SIDS; DTP, OPV, HIB given 25NOV91; no rxn for 44 hrs p/vax; mom noted irritability for 2 hrs then found pt dead p/being asleep for 2 hrs;


VAERS ID: 38196 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:1991-10-24
Onset:1991-10-28
   Days after vaccination:4
Submitted: 1991-11-13
   Days after onset:16
Entered: 1992-01-02
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312934 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 638M2 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Diarrhoea, Gastroenteritis, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-31
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 24OCT91 normal exam, 1st DTP/OPV/HIB administered; 28OCT91 seen in office for gastroenteritis & acneform rash; 30OCT91 mom called diarrhea, continues, now vomiting also; sent to ER; 31OCT91 pt died;


VAERS ID: 38733 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-14
   Days after vaccination:1
Submitted: 1991-12-05
   Days after onset:52
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-17
   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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


VAERS ID: 38734 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-13
   Days after vaccination:0
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Haematemesis, Hyperhidrosis, Pallor, Right ventricular failure, Tremor
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-15
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt had diabetes, congestive heart failure & a peptic ulcer;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361005J

Write-up: w/in hrs of receiving flu vax pt began shaking & exp vomiting w/a small amount of blood noted; following morning pt exp chest pain, SOB, paleness & clamminess; pt was hospitalized & died 15OCT91; COD congestive heart failure;


VAERS ID: 38735 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-08
Onset:1991-10-13
   Days after vaccination:5
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-26
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


VAERS ID: 38737 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-10-28
Onset:1991-10-28
   Days after vaccination:0
Submitted: 1991-12-10
   Days after onset:43
Entered: 1992-01-13
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


VAERS ID: 38755 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Carolina  
Vaccinated:1991-12-16
Onset:0000-00-00
Submitted: 1991-12-31
Entered: 1992-01-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306964 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature 3-12oz-premture rupture membrane
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC92002

Write-up:


VAERS ID: 38761 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Maryland  
Vaccinated:1992-01-06
Onset:1992-01-09
   Days after vaccination:3
Submitted: 1992-01-11
   Days after onset:2
Entered: 1992-01-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312933 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HH / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312913 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Diarrhoea, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-09
   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: NONE
Current Illness: congestion
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd immun 6JAN92 & had normal exam @ that time; 3 days later was cranky & had some diarrhea later that afternoon was found in crib by babysitter unresponsive; paramedics called & pt taken to local hosp; resusitative efforts unsuccessfu


VAERS ID: 38762 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-12-10
Onset:1991-12-16
   Days after vaccination:6
Submitted: 1992-01-09
   Days after onset:24
Entered: 1992-01-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314958 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 12282 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646E / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Pyrexia, Skin nodule, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: 1991-12-16
   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:

Write-up: Fever 102,knot on leg, cried alot on 16DEC91 found dead by father SID death-no autopsy;


VAERS ID: 38816 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: Nevada  
Vaccinated:1991-11-26
Onset:1991-12-18
   Days after vaccination:22
Submitted: 1992-01-07
   Days after onset:20
Entered: 1992-01-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


VAERS ID: 38824 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:1991-11-14
Onset:1991-11-29
   Days after vaccination:15
Submitted: 1992-01-13
   Days after onset:45
Entered: 1992-01-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Cerebral haemorrhage, Convulsion, Gingival bleeding, Haematuria, Myocardial infarction, Petechiae, Thrombocytopenia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Ventricular tachyarrhythmias (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Gingival disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Tubulointerstitial diseases (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Pt exp generalized weakness, thrombocytopenic purpura, thrombocytopenia @ 43yo~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt was exp to many petro chemicals, paint & glue; suffered from diabetes mellitus type II which was dx last yr & treated w/diet only;
Allergies:
Diagnostic Lab Data: 21NOV91 platelets were 5,000; bleeding time $g10 mins; prothrombin time of 15 vs 12; quick 65%; p/the hosp admission (? 7th day of admission platelet count was 24,000);
CDC Split Type: EBW918091

Write-up: 21NOV91 8(?) days p/2nd dose pt exp thrombocytopenia w/petechiae, bleeding gums & hematuria; Pt hospitalized & anti-platelet antibodies detected; 7th day of admission pt suddenly collapsed w/a fit; cerebral bleeding suspected; mass MI & VF;


VAERS ID: 38828 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1991-11-21
Onset:1991-12-01
   Days after vaccination:10
Submitted: 1991-12-27
   Days after onset:26
Entered: 1992-01-16
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306926 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310959 / 1 MO / PO

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

Life Threatening? 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: NONE
Preexisting Conditions: SGA- full term 4lb 10 oz
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt found in crib arrested not able to resuscitate suspected SIDS by med examiner;


VAERS ID: 38869 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:1991-11-01
Onset:1991-12-01
   Days after vaccination:30
Submitted: 1991-12-19
   Days after onset:18
Entered: 1992-01-17
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Not specified;
CDC Split Type: 891360001J

Write-up: Nursing home pt devel a stroke approx 1 month p/being administered flu vax, pt subsequently expired;


VAERS ID: 38984 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:1991-11-08
Onset:1991-11-15
   Days after vaccination:7
Submitted: 1992-01-17
   Days after onset:63
Entered: 1992-01-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK - / A

Administered by: Public       Purchased by: Private
Symptoms: Apnoea, Guillain-Barre syndrome, Myasthenic syndrome, Neuropathy, Paraesthesia, Pneumonia, Pyrexia, Speech disorder
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-04
   Days after onset: 50
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ATB for pneumonia p/hosp
Current Illness: UNK
Preexisting Conditions: heart murmmer, takes Naprosyn
Allergies:
Diagnostic Lab Data: CSF nl, ABG''s nl; CBC-WBC 9,200, HGB 16.1, HCT 44.9; plat 218,000; ESR-6; IgG 421 dec; Drug screen neg; nerve conduction velocity study; suggests GBS, acute polyneuropathy;
CDC Split Type:

Write-up: 15NOV91 tingling fingers & toes lt side numbness rt hand & foot; fatigue & muscular weakness; inc temp speech became more difficult; 19NOV91 placed on ventilator, only able to move lips shrug shoulder (tracheotomy); pneumonia;


VAERS ID: 39013 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Missouri  
Vaccinated:1991-11-15
Onset:1991-11-17
   Days after vaccination:2
Submitted: 1992-01-10
   Days after onset:54
Entered: 1992-01-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306926 / 1 GM / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 1 GM / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06329 / 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: 1991-11-17
   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: NONE
Current Illness: NONE
Preexisting Conditions: minor malformation aortic arch-origin lt vert A
Allergies:
Diagnostic Lab Data: post mortem exam consistent w/sids;
CDC Split Type:

Write-up: Pt slept on couch @ home last seen alive 3AM 17NOV91 when mom awakened about 9AM; baby dead;


VAERS ID: 39014 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Female  
Location: Illinois  
Vaccinated:1991-11-12
Onset:1991-12-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-15
   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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


VAERS ID: 39029 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:1991-09-19
Onset:1991-09-20
   Days after vaccination:1
Submitted: 1991-10-28
   Days after onset:38
Entered: 1992-01-24
   Days after submission:88
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0680T / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypokinesia
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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pt recvd Hepatitis B Immune Globulin; Phytonadione, Erythromycin, Ophthalmic
Current Illness: Mom Hep B positive
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood C&S neg, good apgars post partum-9 & 9 @ 1 & 5 minutes; no other significant labs;
CDC Split Type:

Write-up: Immediately post partum, neonate was administered Hep B vax & Hep Immune globulin & 24 hrs later the neonate was found in crib postioned on abdomen w/head turned to lt side, color was cyanotic; no resp, pulse, or spontaneous movements;


VAERS ID: 39041 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1992-01-04
Onset:1992-01-05
   Days after vaccination:1
Submitted: 1992-01-13
   Days after onset:8
Entered: 1992-01-27
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

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: 1992-01-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


VAERS ID: 39068 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1992-01-07
Onset:1992-01-08
   Days after vaccination:1
Submitted: 1992-01-09
   Days after onset:1
Entered: 1992-01-27
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310966 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641D / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: seen by MD 6JAN92 told mom URI but OK for immun
Allergies:
Diagnostic Lab Data: Autopsy was performed/no significant findings according to MD;
CDC Split Type: TN9211

Write-up: MD reported no other adverse events other than the pt was last seen on 8JAN92 @ 6AM alive & was found on 8JAN92 1130AM dead by mom;


VAERS ID: 39077 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-11-20
Onset:1991-11-20
   Days after vaccination:0
Submitted: 1992-01-20
   Days after onset:61
Entered: 1992-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Myocardial infarction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-20
   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: Calan, Synthroid, Feldene
Current Illness: NONE
Preexisting Conditions: No known allergies; hypertension, hypothyroidism, arthritis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt was administered flu vax @ approx 1215 PM 20NOV91 VS-nl; pt had taken flu vax previously remained in the clinic for 15 to 20mins p/inject; pt passed out on the golf course @ approx 2PM to ER dx MI; no evidence of allergic rxn;


VAERS ID: 39087 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:1991-12-19
Onset:1991-12-19
   Days after vaccination:0
Submitted: 1992-01-24
   Days after onset:36
Entered: 1992-01-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PLAGUE: PLAGUE (NO BRAND NAME) / MILES LABORATORIES - / 3 - / IM A

Administered by: Military       Purchased by: Military
Symptoms: Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt exp urticaria & rash p/vaxs; MAY91 hospitalized for anaphylaxis;~ ()~~~In patient
Other Medications: Pt recvd Japanese B Encephalitis vax by Cannaught Labs SQ 17DEC91;
Current Illness: NA
Preexisting Conditions: Pt had hx of anaphylactic rxn, including bee stings;
Allergies:
Diagnostic Lab Data: Autopsy neg x/for presence of eosinophiles in lungs;
CDC Split Type: 33026

Write-up: Pt recvd Japanese B Encephalitis vax followed in 48 hrs by Plague vax; @ approx 1230AM next day pt was found unresponsive & apparently dead; Pt previously recvd 2 doses of Plague w/no problems reported;


VAERS ID: 39159 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Unknown  
Location: New Hampshire  
Vaccinated:1991-05-09
Onset:1991-07-22
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

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: 1991-07-22
   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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS, but was 73 days p/immun;


VAERS ID: 39263 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Oregon  
Vaccinated:1991-10-31
Onset:0000-00-00
Submitted: 1991-12-16
Entered: 1992-01-31
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 3 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: mom HBSAG pos 6SEP90 neg 15JAN91 pt recvd HBIG 21MAR91;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR922

Write-up: Expired 8NOV91 dx SIDS;


VAERS ID: 39274 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Wisconsin  
Vaccinated:1991-10-28
Onset:1991-11-06
   Days after vaccination:9
Submitted: 1991-12-10
   Days after onset:34
Entered: 1992-01-31
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300922 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0635H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Arrhythmia, Bradycardia, Urinary tract infection
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-11
   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: Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: abn 8th chromosome, Av canal pulmonary atresia, PDA, VSD, CHF;
Allergies:
Diagnostic Lab Data: unavailable;
CDC Split Type: WI91088

Write-up: Pt born w/chromosomal & cardiac abnormalities; Hospitalized 6NOV91 w/UTI per clinic; died 11NOV91 COD bradyarrhythmia due to CHF due to congenital heart defect;


VAERS ID: 39281 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1991-11-13
Onset:1991-11-18
   Days after vaccination:5
Submitted: 1992-01-16
   Days after onset:59
Entered: 1992-01-31
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia
SMQs:, Agranulocytosis (broad), Gastrointestinal perforation (narrow), Oropharyngeal infections (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


VAERS ID: 39282 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Oregon  
Vaccinated:1991-10-16
Onset:1991-11-27
   Days after vaccination:42
Submitted: 1991-12-18
   Days after onset:21
Entered: 1992-01-31
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560HF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0640K / 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: 1991-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NONE SIDS death 6 wks after;


VAERS ID: 39283 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1991-10-08
Onset:1991-10-26
   Days after vaccination:18
Submitted: 1991-12-17
   Days after onset:52
Entered: 1992-01-31
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1B21062 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 30948 / 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: 1991-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt died 26OCT91 attributed to SIDS per autopsy 28OCT91;


VAERS ID: 39284 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1991-01-17
Onset:1991-01-31
   Days after vaccination:14
Submitted: 1992-01-27
   Days after onset:361
Entered: 1992-01-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295977 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: NONE
CDC Split Type:

Write-up: Sudden infant death synd;


VAERS ID: 39340 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1992-01-14
Onset:1992-01-15
   Days after vaccination:1
Submitted: 1992-01-15
   Days after onset:0
Entered: 1992-02-04
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0649A / 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: 1992-01-15
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete autospy by MD neg;
CDC Split Type: WA92677

Write-up: Pt found dead in crib presumed by investigators as SIDS;


VAERS ID: 39341 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Washington  
Vaccinated:1991-11-19
Onset:1991-11-20
   Days after vaccination:1
Submitted: 1991-11-20
   Days after onset:0
Entered: 1992-02-04
   Days after submission:76
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 LA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643C / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Adrenal insufficiency, Hypervolaemia, Pulmonary oedema, Pyrexia, Respiratory disorder, Shock, Vasodilatation
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Tempra
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WA92678

Write-up: Went to bed w/o evidence of fever or irritability; found dead by mom in morning;


VAERS ID: 39377 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1992-01-20
Onset:1992-01-22
   Days after vaccination:2
Submitted: 1992-02-04
   Days after onset:13
Entered: 1992-02-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314908 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306956 / 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: 1992-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Rondec
Current Illness: mild cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy; no abnormality
CDC Split Type:

Write-up: SIDS (crib death);


VAERS ID: 39411 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1992-01-09
Onset:1992-01-18
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1992-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314908 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HJ / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646L / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Pyrexia, Rash, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: 1992-01-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pediazole
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died 18JAN92; last nursed 1800 on 17JAN; slept w/mom when mom awakened @ 0500 on 18JAN, pt was dead; by report, temp was still 101.7 R on arrival in ER;


VAERS ID: 39412 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1992-01-31
Onset:1992-02-01
   Days after vaccination:1
Submitted: 1992-02-05
   Days after onset:4
Entered: 1992-02-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145FJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-01
   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: APAP
Current Illness: mild congestion
Preexisting Conditions: hernia, hydrocoele, constipation
Allergies:
Diagnostic Lab Data: Autopsy diagnosis SIDS:
CDC Split Type:

Write-up: Hosp notified 1FEB92 that pt had died;


VAERS ID: 39413 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-12-27
Onset:1992-01-20
   Days after vaccination:24
Submitted: 1992-01-29
   Days after onset:9
Entered: 1992-02-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316915 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310928 / 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: 1992-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SIDS-confirmed;
CDC Split Type:

Write-up: NONE-SIDS death 3 wks p/


VAERS ID: 39455 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:1991-12-14
Onset:1991-12-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


VAERS ID: 39586 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Nevada  
Vaccinated:1992-02-07
Onset:1992-02-08
   Days after vaccination:1
Submitted: 1992-02-12
   Days after onset:4
Entered: 1992-02-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac failure, Coronary artery disease
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: Acute coronary failure secondary to CAD;


VAERS ID: 39615 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Delaware  
Vaccinated:1991-12-16
Onset:1991-12-22
   Days after vaccination:6
Submitted: 1992-02-11
   Days after onset:51
Entered: 1992-02-21
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0642D / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bone marrow depression, Delirium, Haemorrhage, Lung disorder, Petechiae, Pulmonary haemorrhage, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Myelodysplastic syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-22
   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: Bactrim
Current Illness: serous otitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4129

Write-up: SIDS;


VAERS ID: 39636 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Missouri  
Vaccinated:1992-01-02
Onset:1992-01-04
   Days after vaccination:2
Submitted: 1992-01-06
   Days after onset:2
Entered: 1992-02-24
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312934 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M580HC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314933 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO92006

Write-up: T101 Thursday 2JAN92 PM-temp controlled w/Tempra; pts death was a result of SIDS;


VAERS ID: 39638 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-02-06
Onset:1992-02-06
   Days after vaccination:0
Submitted: 1992-02-13
   Days after onset:7
Entered: 1992-02-24
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314957 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0635F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC92005

Write-up: Pt was DOA @ ER on 10FEB92; Family reported pt had fun fever since shots on 10FEB92; temp on arrival was 103.4; Pathology report was presumptive SIDS;


VAERS ID: 39713 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:1991-12-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Encephalitis, Encephalopathy, Movement disorder, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Diabinese, Procardia XL, Tenormin, Capoten, Provachol, Aldactone, Lasix;
Current Illness:
Preexisting Conditions: Type II DM-incr chol, HTN, CHF;
Allergies:
Diagnostic Lab Data: EEG-?temporal lobe problem, MRI; lab eval none positive;
CDC Split Type:

Write-up: Pt devel encephalopathy thought to be encephalitis-unknown cause; (initially c/o numbness rt hand x 2 wks opposite arm from inject then deterioration of motor skills & mental status over 5 days;


VAERS ID: 39742 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


VAERS ID: 39743 (history)  
Form: Version 1.0  
Age: 104.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-27
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK GM / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


VAERS ID: 39744 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-10-28
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


VAERS ID: 39745 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-29
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-05
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


VAERS ID: 39746 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-11-06
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308912 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Lasix PRN
Current Illness: mild CHF, end stage liver disease
Preexisting Conditions: NKA, hepatic encephalopathy, hx hyponatremia, mild CHF,dry gangrene;
Allergies:
Diagnostic Lab Data: End stage liver disease 21OCT91 Ammonia level=148 (ref range 11-35); BUN=25, serum creatinine=1.6;
CDC Split Type: HI9206

Write-up: adm dx mild CHF, dry gangrene; final dx cardiac resp arrest, ASCVD, cirrhosis; pt died 7NOV91;


VAERS ID: 39780 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:1992-01-27
Onset:0000-00-00
Submitted: 1992-02-03
Entered: 1992-03-04
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306928 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314946 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd vax 27JAN92; Notified on 30JAN92 by parents that pt had expired; clinic requested that VAERS form be completed;


VAERS ID: 39885 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1992-02-14
Onset:1992-02-21
   Days after vaccination:7
Submitted: 1992-02-26
   Days after onset:5
Entered: 1992-03-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M60HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310935 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: granuloma of umbilicus treated w/silver nitrate on 14FEB92
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA92016

Write-up: Pt unable to be aroused on 21FEB92 approx 7AM; rescue squad called, CPR initiated & transported to hosp; unable to resuscitate; cause of death on certificate SIDS; no signs of illness prior to incident;


VAERS ID: 39932 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Utah  
Vaccinated:1992-02-18
Onset:1992-02-18
   Days after vaccination:0
Submitted: 1992-02-19
   Days after onset:1
Entered: 1992-03-09
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1B31125 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0644C / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Haemorrhage, Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report pending;
CDC Split Type: 920032201

Write-up: Pt recvd HIB/OPV/DTP on 18FEB92 & 3 hrs later pt died; pt just recently recvd well care check-up which was nl; probable SIDS; autopsy being performed;


VAERS ID: 39988 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-10-01
Onset:1991-10-02
   Days after vaccination:1
Submitted: 1991-10-03
   Days after onset:1
Entered: 1992-03-09
   Days after submission:158
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297905 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 300948 / 2 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: 1991-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy showed COD SIDS;
CDC Split Type: PA91321

Write-up: Pt recvd DTP/OPV/HIB #2 in the AM of 1OCT91 pt found dead in crib Tues AM; pt was fine when went to bed Mon night;


VAERS ID: 40098 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-12-10
Onset:1991-12-10
   Days after vaccination:0
Submitted: 1992-01-28
   Days after onset:49
Entered: 1992-03-09
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304922 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125HF / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 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: 1991-12-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9235

Write-up: Coroner ruled SIDS death;


VAERS ID: 40207 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Idaho  
Vaccinated:1992-01-27
Onset:1992-01-28
   Days after vaccination:1
Submitted: 1992-03-02
   Days after onset:34
Entered: 1992-03-16
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310966 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0637F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pneumonia, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: 1992-02-23
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: ID92020

Write-up: Pt recvd vax on 27JAN92 approx 1PM; began running inc temp approx 9PM; On 28JAN92 inc temp went up to 102; inc temp went up & down; went to PMD 29JAN & on 30JAN hospitalized; 1FEB92 bronchial pneumonia;


VAERS ID: 40221 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-01-17
Onset:1991-02-09
   Days after vaccination:23
Submitted: 1992-03-12
   Days after onset:397
Entered: 1992-03-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295977 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0609K / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-09
   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:
Current Illness: NONE
Preexisting Conditions: congential hip
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


VAERS ID: 40309 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:1992-03-13
Onset:1992-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1992-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322909 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 312913 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-14
   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: healthy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd vax 13MAR92 & expired on 14MAR92 @ 1235PM: pt had seizure prior to expiring;


VAERS ID: 40527 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1991-12-16
Onset:1991-12-16
   Days after vaccination:0
Submitted: 1992-01-06
   Days after onset:21
Entered: 1992-03-23
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Haemorrhage, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WA92673

Write-up: SIDS found dead in crib;


VAERS ID: 40551 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1992-03-09
Onset:1992-03-11
   Days after vaccination:2
Submitted: 1992-03-16
   Days after onset:5
Entered: 1992-03-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2013T / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M135HF / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

Administered by: Public       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Neuropathy, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), 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 (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-14
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hydorcortisone, Nystatin ointment;
Current Illness: candida diaper derm-oral candiasis
Preexisting Conditions: probable milk allergy 4FEB92; otitis-cleared, thrush 18FEB92;
Allergies:
Diagnostic Lab Data: CT of head, abdomen; autopsy;
CDC Split Type:

Write-up: After being cllinically well, pt was found asystolic w/o respiration; this was felt to be SIDS; resusitation was begun & pt brough to ER; over next 2-3 days pt showed evidence of severe neuro damage & multiple organ failure;


VAERS ID: 40552 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Hampshire  
Vaccinated:1991-06-24
Onset:0000-00-00
Submitted: 1992-03-17
Entered: 1992-03-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 635G6 / 2 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: 1991-07-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS;


VAERS ID: 40606 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-12-19
Onset:1991-12-20
   Days after vaccination:1
Submitted: 1992-03-20
   Days after onset:91
Entered: 1992-03-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1B31125 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 645K4 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-20
   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: APAP, Pediacare
Current Illness: NONE
Preexisting Conditions: URI 2 wks prior resolved by 19DEC91;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB & was given APAP for fever; mom lost APAP & gave pt few doses of pedicare; pt found dead in crib next morning 10AM;


VAERS ID: 40811 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Florida  
Vaccinated:1992-03-12
Onset:1992-03-14
   Days after vaccination:2
Submitted: 1992-03-25
   Days after onset:11
Entered: 1992-03-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314958 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700HL / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: cold, runny nose, cough
Preexisting Conditions: complex congenital heart disease (single atrium, single ventricle, pulmonary stenosis, single AV valve, dextrocardia, PDA, inferior vena cava shunt to lt superior vena cava;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died two day p/vax;


VAERS ID: 40951 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-12-19
Onset:1991-12-27
   Days after vaccination:8
Submitted: 1992-03-24
   Days after onset:88
Entered: 1992-04-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21215 / UNK - / IM A

Administered by: Private       Purchased by: Public
Symptoms: Cardiac arrest, Coagulopathy, Dyspnoea, Lactic acidosis, Pharyngitis, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-01-05
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Chemotherapy w/Cytoxan, Vincristine, Procarbazine, Pred, & Bleomycin
Current Illness: Lymphoma
Preexisting Conditions: lymphoma, leukemia
Allergies:
Diagnostic Lab Data: CXR
CDC Split Type: PA9280

Write-up: 27DEC91 fever, fatigue, weak; 28DEC91 t102, ATB recvd; 31DEC91 fever, cough worse to hosp ER; cxr done; not admitted; 1JAN92 to hosp ER was admitted; heart stopped in ICU died 5JAN92;


VAERS ID: 41018 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-02-11
Onset:1992-02-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1992-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314957 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HJ / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0645H / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete autopsy; no anatomic cause;
CDC Split Type: SD92004

Write-up: DOA- autopsy done; MD couldn''t implicate vax;


VAERS ID: 41125 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:1992-03-04
Onset:1992-03-05
   Days after vaccination:1
Submitted: 1992-03-26
   Days after onset:21
Entered: 1992-04-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31006 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700HC / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0647L / 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: 1992-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: soft cardiac murmur-no organic reason thought
Allergies:
Diagnostic Lab Data: coroner;
CDC Split Type: MO92012

Write-up: SIDS the night or early AM p/vax given;


VAERS ID: 41138 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1992-04-01
Onset:1992-04-02
   Days after vaccination:1
Submitted: 1992-04-02
   Days after onset:0
Entered: 1992-04-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318909 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308979 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt found dead by parents;


VAERS ID: 41169 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Colorado  
Vaccinated:1992-02-05
Onset:1992-02-09
   Days after vaccination:4
Submitted: 1992-02-12
   Days after onset:3
Entered: 1992-04-09
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308982 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0645L / 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: 1992-02-09
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Preliminary autopsy results SIDS;
CDC Split Type: CO92016

Write-up: Found deceased in crib morning of 9FEB92 by mom of pt; taken to ER declared dead;


VAERS ID: 41251 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1992-03-23
Onset:1992-03-24
   Days after vaccination:1
Submitted: 1992-03-27
   Days after onset:3
Entered: 1992-04-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322909 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150HN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316958 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dehydration, Delirium, Electrolyte imbalance, Enterocolitis, Infection, Pyrexia, Skin ulcer, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-25
   Days after onset: 1
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: 2 siblings-no problems following vax; twin sister died 26MAR92 following vax;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood Cultures-neg; Autopsy is currently being performed by med examiner;
CDC Split Type: 920074501

Write-up: 1 of 2 pts (twins) recvd DTP/HBOC/OPV on 23MAR92 & 24MAR devel nausea, vomiting, & fever; Seen in ER on 25MAR & hospitalized; BC neg; pt died w/in 13 hrs of admittance on 25MAR;


VAERS ID: 41252 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1992-03-23
Onset:1992-03-24
   Days after vaccination:1
Submitted: 1992-03-27
   Days after onset:3
Entered: 1992-04-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322909 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150HN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316958 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dehydration, Delirium, Electrolyte imbalance, Enterocolitis, Infection, Pyrexia, Skin ulcer, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-26
   Days after onset: 2
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: 2 siblings-no problems following vax; twin brother died 25MAR92 following vax;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: BC-neg; Autopsy is currently being performed by med examiner;
CDC Split Type: 920074502

Write-up: 1 of 2 pts (twins) recvd DTP/HBOC/OPV on 23MAR92; 24MAR devel nausea, vomiting, & fever; seen in ER on 25MAR & hospitalized; BC neg; pt died 26MAR;


VAERS ID: 41254 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1992-03-30
Onset:1992-04-02
   Days after vaccination:3
Submitted: 1992-04-13
   Days after onset:10
Entered: 1992-04-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 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: 1992-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4209

Write-up: Probable SIDS p/vax; well baby visit;


VAERS ID: 41278 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Louisiana  
Vaccinated:1992-03-17
Onset:1992-03-17
   Days after vaccination:0
Submitted: 1992-03-30
   Days after onset:13
Entered: 1992-04-20
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-22
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SIDS
CDC Split Type: LA920401

Write-up: Redness @ site of inject same day;


VAERS ID: 41281 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oklahoma  
Vaccinated:1992-03-31
Onset:1992-04-02
   Days after vaccination:2
Submitted: 1992-04-14
   Days after onset:11
Entered: 1992-04-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308924 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308954 / 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: 1992-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx pneumonia; Seen by MD 31MAR92 AM; nl cxr;
Allergies:
Diagnostic Lab Data: Autopsy- SIDS
CDC Split Type: OK9215

Write-up: 2 days following immun mom had in bed w/her; mom awoke & pt had stopped breathing; Pt taken to hosp & was pronounced DOA;


VAERS ID: 41339 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Virginia  
Vaccinated:1992-03-11
Onset:1992-03-16
   Days after vaccination:5
Submitted: 1992-04-14
   Days after onset:28
Entered: 1992-04-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320906 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 3 RL / -

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: 1992-03-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Ferrin sol drop
Current Illness: NONE
Preexisting Conditions: on 17FEB92 URI & mild anemia, responded to iron
Allergies:
Diagnostic Lab Data: Autopsy done, gross finding not remarkable, final report not available yet;
CDC Split Type:

Write-up: Sudden death 5 days p/DTP/HIB on 11MAR92; pt was seen for well bay check up, was active, alert, & happy, PE was completely nl; Pt seen by M in good hlth; on 16MAR92 pt was placed in playpen @ 5PM & was found dead about 515PM;


VAERS ID: 41340 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1992-03-11
Onset:1992-03-17
   Days after vaccination:6
Submitted: 1992-04-09
   Days after onset:22
Entered: 1992-04-20
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 314908 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M665HH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314942 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: laryngomalacia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brought to ER dead p/unable to arouse @ home; probable SIDS;


VAERS ID: 41362 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alaska  
Vaccinated:1992-03-12
Onset:1992-03-29
   Days after vaccination:17
Submitted: 1992-04-02
   Days after onset:4
Entered: 1992-04-22
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310965 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1283T / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306964 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Decongestant from MD
Current Illness: sl cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AK92011

Write-up: Pt dead on 29MAR92 cause of death not yet determined;


VAERS ID: 41374 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: New Hampshire  
Vaccinated:1992-02-26
Onset:1992-03-19
   Days after vaccination:22
Submitted: 1992-03-26
   Days after onset:7
Entered: 1992-04-22
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-21
   Days after onset: 2
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: unk
CDC Split Type: NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


VAERS ID: 41572 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arizona  
Vaccinated:1992-04-15
Onset:0000-00-00
Submitted: 1992-04-23
Entered: 1992-04-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31005 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HN / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 649B5 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: No immediate rxn pt found dead in bed 23APR92;


VAERS ID: 41588 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1992-02-11
Onset:1992-02-11
   Days after vaccination:0
Submitted: 1992-04-23
   Days after onset:71
Entered: 1992-04-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643K / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Cyanosis, Hypotonia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-12
   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: NONE
Current Illness: CHD
Preexisting Conditions: pulmonary artresia & VSD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/congenital heart disease (pulmonary artresia & VSD) w/chronic desaturation but otherwise stable; pt was irritable p/vax & that noc became more irritable & difficult to console; became limp & cyanotic; EMTs called-taken to ER;


VAERS ID: 41658 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Washington  
Vaccinated:1992-03-17
Onset:1992-03-17
   Days after vaccination:0
Submitted: 1992-03-18
   Days after onset:1
Entered: 1992-04-30
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 2 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646L / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Brain oedema, Cardiac arrest, Encephalopathy, Gastrointestinal necrosis, Hepatocellular damage, Pulmonary haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hyponatraemia/SIADH (broad), Ischaemic colitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-03-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Toxicology screen-neg;
CDC Split Type: WA92697

Write-up: Pt adm to ER about 2030 cardiopulmonary arrest-no fever transferred to another hosp & placed on life support-taken off ventilator 2100 18MAR92 & expired;


VAERS ID: 41711 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Louisiana  
Vaccinated:1992-04-01
Onset:1992-04-01
   Days after vaccination:0
Submitted: 1992-04-13
   Days after onset:11
Entered: 1992-05-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC Split Type: LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


VAERS ID: 41862 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Nebraska  
Vaccinated:1991-12-12
Onset:1991-12-22
   Days after vaccination:10
Submitted: 1992-04-30
   Days after onset:129
Entered: 1992-05-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / 7+ LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Anaemia, Asthenia, Malaise, Myelofibrosis, Oedema peripheral, Otitis media
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Blood premalignant disorders (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NE9212

Write-up: 10 days p/flu vax felt poorly-tired; MD tests done found to be very anemic; dx rare acute myleofibrosis of the bone; gets blood transfusions every 2 wks; has also had ear infects & now swelling of the feet is very weak;


VAERS ID: 41868 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: California  
Vaccinated:1992-04-16
Onset:1992-04-24
   Days after vaccination:8
Submitted: 1992-05-05
   Days after onset:11
Entered: 1992-05-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2G31010 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 3 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: 1992-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic serous Lt OM;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recvd vax 16APR92, & expired 24APR92; ?SIDS;


VAERS ID: 41869 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1992-04-27
Onset:1992-04-27
   Days after vaccination:0
Submitted: 1992-04-29
   Days after onset:2
Entered: 1992-05-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560HF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 648H / 1 MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Anorexia, Petechiae, Stupor
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pts sibling crying inconsolable, fever @ 3mos w/DTP #1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type:

Write-up: Pt recvd vax @ approx 2PM, poor feeding @ approx 6PM; found unresponsive approx 12AM; DOA on arrival to ER; petechiae on thymus;


VAERS ID: 41896 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:1992-04-29
Onset:1992-05-01
   Days after vaccination:2
Submitted: 1992-05-06
   Days after onset:5
Entered: 1992-05-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322910 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 318946 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: mild eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd DTP/OPV/HIB 29APR92 930AM;w/no problems; no fever; no fussy; very active & playful afternoon of 1MAY92; fed 6PM 1MAY92 was OK in crib 15 min later 635PM found pulseless & not breathing; intubated & given meds; ?SIDS, lung congest


VAERS ID: 41897 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Oregon  
Vaccinated:1992-01-15
Onset:1992-01-22
   Days after vaccination:7
Submitted: 1992-03-23
   Days after onset:61
Entered: 1992-05-12
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: vitamins only
Current Illness: NONE
Preexisting Conditions: smoker, hx IV drugs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS;


VAERS ID: 42033 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Montana  
Vaccinated:1992-04-09
Onset:1992-04-18
   Days after vaccination:9
Submitted: 1992-04-20
   Days after onset:2
Entered: 1992-05-18
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 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: 1992-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MT92007

Write-up: On 7MAR92 pt seen in ER for coughing & gagging episode; no color change; resolved spontaneously; 18APR92 parent checked on pt @ 630; pt appeared fine; checked again 0930 pt was dead preliminary cause of death listed as SIDS;


VAERS ID: 42039 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Texas  
Vaccinated:1992-02-25
Onset:1992-03-07
   Days after vaccination:11
Submitted: 1992-05-11
   Days after onset:64
Entered: 1992-05-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


VAERS ID: 42047 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Michigan  
Vaccinated:1992-04-30
Onset:1992-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1992-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1217A / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643L / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Atelectasis, Bronchitis, Cardiac arrest, Cyanosis, Lymphadenopathy, Petechiae, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-01
   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: pt had a UTI 1st wk of life;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: @ 5AM on 1MAY92 pt was fed & put to sleep, 45 min later pt was foun blue & not breathing; despite CPR & ALLS rescue techniques pt died;


VAERS ID: 42073 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: California  
Vaccinated:1991-08-21
Onset:1991-08-21
   Days after vaccination:0
Submitted: 1992-05-18
   Days after onset:271
Entered: 1992-05-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Bronchitis, Convulsion, Febrile convulsion, Gastroenteritis, Hemiplegia, Hypokinesia, Meningitis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-03-18
   Days after onset: 210
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 19NOV91 CSF-nl; 18JAN92 BC-pos alapha strep; 23AUG91 CT Scan-nl; MRI-nl
CDC Split Type: WAES91090035

Write-up: Pt recvd 2nd dose HIB vax 21AUG91 & exp tonic-clonic activity; pt taken to ER; flaccid; taken to another hosp dec movement of extremities; hemiparesis; weakness; 7SEP91 febrile sz & aseptic meningitis; gastroenteritis, bronchitis, epileptic


VAERS ID: 42200 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Oregon  
Vaccinated:1992-03-23
Onset:1992-04-01
   Days after vaccination:9
Submitted: 1992-05-04
   Days after onset:32
Entered: 1992-05-28
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 2 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308960 / 2 - / -

Administered by: Other       Purchased by: Public
Symptoms: Dyspnoea, Pharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-03
   Days after onset: 2
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: Valium, Phenobarb, Zantac, Vancenase spray;
Current Illness: resp failure due to aspiration
Preexisting Conditions: Perinatal anoxia, seizure disorder, apnea, reflux no swallow, tube feedings
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR9236

Write-up: Pt recvd vax 23MAR92 no apparent fever until 1APR92 when pt had inc resp difficulties & fever; pt was treated w/APAP & decongestants until 3APR92 when ATB & inhalatin tx ordered pt expired a/recvd tx;


VAERS ID: 42220 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: Wyoming  
Vaccinated:1991-10-18
Onset:1991-10-21
   Days after vaccination:3
Submitted: 1991-10-22
   Days after onset:1
Entered: 1992-05-28
   Days after submission:219
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


VAERS ID: 42254 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1992-03-04
Onset:1992-03-08
   Days after vaccination:4
Submitted: 1992-05-22
   Days after onset:74
Entered: 1992-05-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308924 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HJ / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 646L6 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-08
   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: APAP
Current Illness: recovering from URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS, nl;
CDC Split Type: PA92139

Write-up: Sudden unexplained infant death of 8MAR92; mom found pt w/o heart beat or resp;


VAERS ID: 42346 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1992-04-30
Onset:1992-04-30
   Days after vaccination:0
Submitted: 1992-05-18
   Days after onset:18
Entered: 1992-06-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0644M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Aortic valve stenosis, Apnoea, Brain oedema, Cardiac arrest, Cardiomegaly, Cardiovascular disorder, Lung disorder, Pulmonary haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WA92720

Write-up: healthy pt made funny face, face turned red, appeared to be holding breath; mom determined not breathing, gave couple puffs, dialed 911; pulmonary artery & aorta w/fibromuscular thickening & stenosis; cardiomegaly; pulmonary congest & hem


VAERS ID: 42457 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:1991-12-19
Onset:1991-12-20
   Days after vaccination:1
Submitted: 1992-06-01
   Days after onset:163
Entered: 1992-06-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PLAGUE: PLAGUE (NO BRAND NAME) / MILES LABORATORIES 10H10A / 3 - / IM A

Administered by: Military       Purchased by: Military
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Cardiac arrest, Laryngitis, Lung disorder, Pulmonary oedema, Urinary tract disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: DPH; pt also had Japanese encephalitis BIKEN/Connaught lot# 49 or 55; 17DEC91;
Current Illness: NONE
Preexisting Conditions: recurrent anaphylaxis, etiology unk
Allergies:
Diagnostic Lab Data: Toxicology drug screen @ autopsy found only lidociane, presumeably from resuscitation; autopsy found no cause of death, identified death as natural, but commented that anaphylaxis was likely cause;
CDC Split Type:

Write-up: Pt recvd plague vax sometime during 19DEC91; @ about 2300 that day, pt was noted by roommate to be reading in bed, healthy & in no distress; about an hr later, roommate awoke to go to bathroom & find pt dead on floor;


VAERS ID: 42471 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1992-03-18
Onset:1992-03-18
   Days after vaccination:0
Submitted: 1992-04-30
   Days after onset:42
Entered: 1992-06-05
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1217A / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HB / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646C / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-29
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sister: t103, 22 mos; DPT #2, OPV #2, MMR #2;~ ()~~~In Sibling
Other Medications: Ceclor & Ventolin
Current Illness: URI
Preexisting Conditions: allergic to milk-URI
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MI92054

Write-up: Had fever p/vax of 99.4 & then to 101 lasted 2 days; never higher than 101; both upper & lower legs were swollen;


VAERS ID: 42588 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1992-04-03
Onset:0000-00-00
Submitted: 1992-04-30
Entered: 1992-06-08
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304520 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155HG / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0649M / 1 MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Influenza
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-08
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: APAP
Current Illness: NONE
Preexisting Conditions: slow wt gain? formula intolernce
Allergies:
Diagnostic Lab Data: RSV
CDC Split Type: TX9266

Write-up: DOA hosp ER 8APR92 AM; death not felt to be vax related;


VAERS ID: 42844 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Georgia  
Vaccinated:1992-03-24
Onset:0000-00-00
Submitted: 1992-04-02
Entered: 1992-06-15
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 312936 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0642M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS;
CDC Split Type: GA9286

Write-up: Found in bed not breathing-CPR began by mom-EMT''s;


VAERS ID: 42890 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:1992-05-13
Onset:1992-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1992-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322913 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Asphyxia, Cardiac arrest, Encephalopathy, Grand mal convulsion, Haemorrhage, Lactic acidosis, Petechiae, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO92035

Write-up: Pt was found cynotic in bed 15MAY92; pt was taken to hosp; asphyxial death consistent w/SIDS;


VAERS ID: 42901 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Jersey  
Vaccinated:1992-05-28
Onset:1992-05-28
   Days after vaccination:0
Submitted: 1992-06-01
   Days after onset:4
Entered: 1992-06-17
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 - / IM L

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: 1992-05-30
   Days after onset: 2
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: Lanoxin; Pt recvd DTP/OPV 27APR92 lot#''s 308923 & 308981;
Current Illness:
Preexisting Conditions: downs synd, congenital heart AV canal, patent ductus arteriosus;
Allergies:
Diagnostic Lab Data: Autopsy is being performed-awaiting results;
CDC Split Type: 920222201

Write-up: Pt recvd vax 28MAY92 @ 2PM & @ 530PM had fever of 103.4; MD recommended APAP & sponge bath via phone; 29MAY fever of 101; no other sx; 30MAY @ 5AM temp nl; found dead in crib @ 630AM; Autopsy being performed;


VAERS ID: 42913 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Montana  
Vaccinated:1992-06-10
Onset:0000-00-00
Submitted: 1992-06-11
Entered: 1992-06-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 29875913 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Oedema, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Vasodilatation
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-11
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: MT92010

Write-up: not known-was not seen by regular hlth care provider prior to death;


VAERS ID: 43060 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New Jersey  
Vaccinated:1992-06-08
Onset:1992-06-09
   Days after vaccination:1
Submitted: 1992-06-09
   Days after onset:0
Entered: 1992-06-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2G31010 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M185HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0649F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recvd DTP/OPV/HIB 8JUN92 & APAP was given for fever; MD recvd a call on 9JUN92 that pt died @ 7AM; Called ME @ 315 on 9JUN92 pt was sleeping w/mom & grandma found pt dead;


VAERS ID: 43158 (history)  
Form: Version 1.0  
Age: 0.8  
Sex: Male  
Location: Montana  
Vaccinated:1992-03-27
Onset:1992-05-22
   Days after vaccination:56
Submitted: 1992-06-16
   Days after onset:25
Entered: 1992-06-25
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298193 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M290HR / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320930 / 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: 1992-05-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy done;
CDC Split Type: MT92013

Write-up: Infant died 22MAY92 from apparent SIDS;


VAERS ID: 43166 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:1992-05-08
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K4709 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure, Endocarditis, Infection
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-13
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: UNK
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: Autopsy planned;
CDC Split Type: WAES92060551

Write-up: Pt recvd MMR vax on 8MAY92 & devel bacterial endocarditis complicated by heart failure & was hospitalized; 13JUN92 pt died due to bacterial endocarditis complicated by heart failure; autopsy is planned;


VAERS ID: 43261 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Arizona  
Vaccinated:1991-08-28
Onset:1991-09-06
   Days after vaccination:9
Submitted: 1992-06-04
   Days after onset:272
Entered: 1992-06-30
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC Split Type:

Write-up:


VAERS ID: 43310 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Texas  
Vaccinated:1992-01-07
Onset:1992-01-08
   Days after vaccination:1
Submitted: 1992-06-12
   Days after onset:155
Entered: 1992-07-02
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 2 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0983T / 1 - / IM L

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Diarrhoea, Encephalopathy, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Pt recvd MMR/HIB 7JAN92 & seen in clinic w/fever, vomiting, diarrhea 10JAN92; 13JAN92 was much improved; seen in clinic 6MAR92 w/ataxia, listlessness adm to hos 17MAR92 dx leukoencephalopathy


VAERS ID: 43356 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-06-26
Onset:1992-06-26
   Days after vaccination:0
Submitted: 1992-06-30
   Days after onset:4
Entered: 1992-07-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M600JA / 1 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Hypertonia, Hypothermia, Pneumothorax, Skin discolouration, Stupor, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to ER in cardiopulmonary arrest; asystole; unresponsive, cold, stiff, eyes fixated, mottling;


VAERS ID: 43425 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-03-04
Onset:1992-03-07
   Days after vaccination:3
Submitted: 1992-06-15
   Days after onset:99
Entered: 1992-07-10
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / L

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Dyspnoea, Hypotonia, Malaise, Movement disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 6months w/DTP #3;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: ? neuropathy
Allergies:
Diagnostic Lab Data: EMG, CSF study;
CDC Split Type: NC92026

Write-up: 3-4 days later pt had loss of head control, unable to sit w/o propping, arms limp, weak cry, labored breathing; listless called MD x 5 days p/vax; returned to hosp 11MAR92 for further eval;


VAERS ID: 43426 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: North Carolina  
Vaccinated:1991-09-09
Onset:1991-09-09
   Days after vaccination:0
Submitted: 1992-06-15
   Days after onset:280
Entered: 1992-07-10
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 300920 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HB / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Movement disorder, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC92027

Write-up: irritable for 1 wk following vax; elevated temp for 1 wk following vax; mom notes hands & arms turning inward; loss of control in upper extremities by 20DEC91;


VAERS ID: 43495 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Washington  
Vaccinated:1992-07-03
Onset:1992-07-03
   Days after vaccination:0
Submitted: 1992-07-07
   Days after onset:4
Entered: 1992-07-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210HK / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0654A / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Diarrhoea, Dyspnoea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-05
   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: NONE
Preexisting Conditions: pulmonary hypertension @ 2 wks secondary to sepsis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: diarrhea & vomitting first 24 hrs; resp distress on 2nd day; arrest on the way to the hosp;


VAERS ID: 43538 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:1992-05-20
Onset:1992-05-29
   Days after vaccination:9
Submitted: 1992-07-13
   Days after onset:45
Entered: 1992-07-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Cyanosis, Insomnia, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pending due to autopsy;
CDC Split Type:

Write-up: pt woke up approx 12AM on 30MAY crying mom felt head was warm; wouldn''t go back to sleep-kept moaning & dozing off; pt very flush & lips were turning purple; pt taken to ER;


VAERS ID: 43579 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Washington  
Vaccinated:1992-05-18
Onset:1992-05-26
   Days after vaccination:8
Submitted: 1992-06-08
   Days after onset:13
Entered: 1992-07-20
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655B / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypertonia
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-26
   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: NONE
Current Illness: 5 days prior @ Swedish conv ER
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy;
CDC Split Type: WA92726

Write-up: brought in ER as moribund & stiff;


VAERS ID: 43601 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-05-15
Onset:1992-06-14
   Days after vaccination:30
Submitted: 1992-07-05
   Days after onset:21
Entered: 1992-07-20
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238V / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M185HF / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0123 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: fluoriode drops, Proventil inhaler
Current Illness: undergoing eval for resp prob
Preexisting Conditions: atrial septal defect; known obstructive hydronephrosis
Allergies:
Diagnostic Lab Data: post mortem;
CDC Split Type:

Write-up: found dead in crib;


VAERS ID: 43631 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1992-07-01
Onset:1992-07-02
   Days after vaccination:1
Submitted: 1992-07-07
   Days after onset:5
Entered: 1992-07-21
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D31006 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316949 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-02
   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: NONE
Current Illness: NONE
Preexisting Conditions: premature pt 34 wk gestation
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9258

Write-up: pt died w/in 24 hrs from time of vax Dx; coroner''s office autopsy-sids;


VAERS ID: 43650 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:1992-07-08
Onset:1992-07-09
   Days after vaccination:1
Submitted: 1992-07-10
   Days after onset:1
Entered: 1992-07-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 326908 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M155JA / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 324945 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS 2 mos of age 1 day p/vax; no known relationship, but timing of sids death warranted report;


VAERS ID: 43651 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1992-07-01
Onset:1992-07-04
   Days after vaccination:3
Submitted: 1992-07-16
   Days after onset:12
Entered: 1992-07-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP279 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-07-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Suprax;
Current Illness: resolving bilat OM;
Preexisting Conditions: cleft palate; s/p neonatal narcotic withdrawl;
Allergies:
Diagnostic Lab Data: post mortem exam SIDS:
CDC Split Type:

Write-up: pt had no sx following admin of vax; fed normally @ 630AM; 4JUL put back to bed was found apneic @ 830AM; taken to local ER where resuscitation unsuccessful; autopsy SIDS;


VAERS ID: 43712 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Oregon  
Vaccinated:1992-05-19
Onset:1992-06-10
   Days after vaccination:22
Submitted: 1992-06-16
   Days after onset:6
Entered: 1992-07-24
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1712S / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp elevated temp @ 16 1/2 mos w/DTP/OPV/HIB/PPD #1 dose;~ ()~~~In patient
Other Medications: PPD by Connaught lot# 233121 29APR91; polyviflor; tums;
Current Illness: afebrile, chronic vegetative state
Preexisting Conditions: abruptio placenta-birth asphyxia-persistent vegetative state microcephaly, temp instability, acute renal tubular necrosis;
Allergies:
Diagnostic Lab Data: G-tube culture/purulent dr/gm stain no bacteria; prelim results WBC''s +1 gm neg bacilli +1; gm pos cocci +1;
CDC Split Type: OR9238

Write-up: 10JUN92 230PM resp distress, color bluish, temp elevated; 02 placed, resp tx given, suctioned, APAP given for temp sudafed given no effect; 730PM resp & cardiac arrest, no code;


VAERS ID: 43807 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kentucky  
Vaccinated:1992-03-23
Onset:1992-04-03
   Days after vaccination:11
Submitted: 1992-04-08
   Days after onset:4
Entered: 1992-07-29
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0651C / 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: 1992-04-03
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: prelim autopsy-SIDS;
CDC Split Type: KY920010

Write-up: pt found lifeless in crib by mom; autopsy reveals SIDS;


VAERS ID: 43820 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Kentucky  
Vaccinated:1992-05-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310965 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HJ / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 310933 / 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: 1992-06-04
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: fx (r) clavicle @ birth (vag);
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY920023

Write-up: SIDS death 4JUN92;


VAERS ID: 43839 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:1992-06-12
Onset:1992-06-14
   Days after vaccination:2
Submitted: 1992-07-16
   Days after onset:32
Entered: 1992-07-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318906 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M120HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 322945 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Atelectasis, Cough, Lung disorder, Petechia