|
| VAERS ID: |
25003 (history) |
| Form: |
Version 1.0 |
| Age: |
0.8 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 1990-01-29 |
| Onset: | 1990-02-04 |
| Days after vaccination: | 6 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium,
Hypokinesia,
Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
|
| VAERS ID: |
25026 (history) |
| Form: |
Version 1.0 |
| Age: |
1.0 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 1990-01-12 |
| Onset: | 1990-01-14 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
229974 / UNK |
- / IM |
| HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
9A11092 / UNK |
- / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
244970 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-01-14
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio |
|
| VAERS ID: |
25028 (history) |
| Form: |
Version 1.0 |
| Age: |
2.0 |
| Sex: |
Male |
| Location: |
Tennessee |
| Vaccinated: | 1989-05-24 |
| Onset: | 1990-06-24 |
| Days after vaccination: | 396 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8L01022 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Meningitis
SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-25
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt admitted with H-Flu meningitis on 24Jun90. Pt expired on 25Jun90. Pt received HIB vaccine at 18 months of age. |
|
| VAERS ID: |
25526 (history) |
| Form: |
Version 1.0 |
| Age: |
45.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 1990-06-08 |
| Onset: | 1990-06-17 |
| Days after vaccination: | 9 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-13 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal pain,
Acidosis,
Anaphylactoid reaction,
Cardiac arrest,
Cardiac failure,
Haematemesis,
Injection site pain,
Pancreatitis,
Pyrexia,
Renal failure
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-19
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 30Jul90- cause of death: anaphylactic shock; the poisonous efectof ingested food stuff causing an accute systemic anaphylactic response which led to acute myocardial failure & ended in cardo-respiratory arrest.
CDC Split Type: CO3526
Write-up: Pt given Imovax rabies on 9-JUN-90 c/o sore arm. 17-JUN-90 pt. had fever & abd tenderness. Family member states worsened. While traveling w/husband pt. began to vomit blood. Taken to ER & admittedto intensive care. Pt had a cardiac arrest |
|
| VAERS ID: |
25530 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Male |
| Location: |
Indiana |
| Vaccinated: | 1990-06-04 |
| Onset: | 1990-06-04 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
262913 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Agitation,
Pyrexia,
Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-05
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001011.01
Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS |
|
| VAERS ID: |
25534 (history) |
| Form: |
Version 1.0 |
| Age: |
4.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 1987-12-09 |
| Onset: | 1990-06-25 |
| Days after vaccination: | 929 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH |
181666 / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Drug ineffective,
Infection
SMQs:, Lack of efficacy/effect (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-25
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001160.01
Write-up: 4 1/2 yr old child 25Jun90/w positive blood culture for h. Influenzae type B. Child received immunization on 9Dec87 |
|
| VAERS ID: |
25535 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Male |
| Location: |
Ohio |
| Vaccinated: | 1990-03-28 |
| Onset: | 1990-03-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271962 / 2 |
- / - |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
259949 / 2 |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-03-28
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy revealed no pathology in any organ system that could explain the death of this infant, therefore, this is a case of sudden death syndrome.
CDC Split Type: 9000592.01
Write-up: normal 4 moth old infant received DTP/OPV in office at on 28Mar90, put to bed at 10:00pm; found dead at 10:30 pm. |
|
| VAERS ID: |
25543 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Unknown |
| Location: |
Wisconsin |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Diarrhoea,
Respiratory disorder
SMQs:, Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001123.01
Write-up: 4 month old infant received first DTP/OPV immun. & had no immediate problems, was apparently well & healthy. 9-10 days later, developed repiratory symptoms & diarrhea, then found dead the following day. |
|
| VAERS ID: |
25553 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Male |
| Location: |
Tennessee |
| Vaccinated: | 1990-06-25 |
| Onset: | 1990-06-27 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9J01114 / UNK |
- / - |
| OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis,
Adrenal haemorrhage,
Lung disorder,
Neoplasm,
Petechiae,
Pulmonary oedema,
Stupor,
Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM. |
|
| VAERS ID: |
25556 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 1989-10-20 |
| Onset: | 1989-10-25 |
| Days after vaccination: | 5 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
42622/1644R / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1989-10-25
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: no relevant history
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy-strep sepsis, The physician & autopsy pathologist felt that the pt''s dealth was not related to vaccination.
CDC Split Type: WAES89100782
Write-up: MD reported pt initially vac. w/ MMR live at 15 mo''s was vac. w/ booster MMR on 10-20-89 along w/ DTP. Pt died 10-25-89. Autopsy = overwhelming strep. sepsis. MD and autopsy pathologist felt pt death not related to vaccination. |
|
