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| VAERS ID: | 26484 | Vaccination Date: | 1990-09-27 | | Age: | 1.5 | Onset Date: | 0000-00-00 Days later: | | Gender: | Female | Submitted: | 1990-10-30 | | State: | California | Entered: | 1990-11-05 | |
| Life Threatening Illness? No |
| Died? Yes (date died: 1990-10-06) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | CONNAUGHT LABORATORIES | | 3 | IM | | | HIBV | CONNAUGHT LABORATORIES | | 0 | IM | | | MMR | MERCK & CO. INC. | | 0 | IM | | | OPV | LEDERLE LABORATORIES | | 2 | PO | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Agitation, Apnoea, Cardiac arrest, Chills, Pain, Pyrexia, Vasodilatation | | Write-up: Pt vaccinated with DTP/OPV/HIB/MMR found apneic in crib on 06OCT90. |
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| VAERS ID: | 26973 | Vaccination Date: | 1990-07-17 | | Age: | 3.6 | Onset Date: | 1990-07-28 Days later: 11 | | Gender: | Female | Submitted: | 1990-11-20 | | State: | California | Entered: | 1990-12-12 | |
| Life Threatening Illness? Yes |
| Died? Yes (date died: 1990-07-28) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': CA9017 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HIBV | CONNAUGHT LABORATORIES | 9B11095 | 0 | | LA | | OPV | LEDERLE LABORATORIES | 275910 | 2 | PO | | |
| Administered by: Public Purchased by: Unknown | | Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock | | Write-up: Pt vaccinated with TOPV/HIB It is not known if pt's illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia. |
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| VAERS ID: | 27059 | Vaccination Date: | 1990-12-03 | | Age: | 0.2 | Onset Date: | 1990-12-04 Days later: 1 | | Gender: | Female | Submitted: | 1990-12-12 | | State: | Washington | Entered: | 1990-12-17 | |
| Life Threatening Illness? Yes |
| Died? No |
| Disability? Yes |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? Yes, days | | Extended hospital stay? No |
| Current Illness: | | Diagnostic Lab Data: Can be obtained at Valley Medical Center, Renton WA, or at Children's Orthopedic Hospital. | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: heart murmur | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | LEDERLE LABORATORIES | 289901 | 0 | IM | | | HIBV | LEDERLE PRAXSIS | MI90FD | 0 | | L | | OPV | LEDERLE LABORATORIES | 291966 | 0 | PO | | |
| Administered by: Private Purchased by: Private | | Symptoms: Cardiac arrest, Coagulopathy, Convulsion | | Write-up: Pt vaccinated with DTP/OPV/HIB developed desiminated intravascular coagulation, emergency resuscitation. Under Intensive care. |
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| VAERS ID: | 28432 | Vaccination Date: | 1991-01-15 | | Age: | 0.3 | Onset Date: | 1991-01-15 Days later: 0 | | Gender: | Male | Submitted: | 0000-00-00 | | State: | Connecticut | Entered: | 1991-02-25 | |
| Life Threatening Illness? No |
| Died? Yes (date died: 1991-01-15) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: hypothyroidism, cranialsynostosis, herni | | Diagnostic Lab Data: blood drawn post immun-all normal, blood drawn in ER possible for alpha strep | | Previous Vaccinations: no | | Other Medications: synthroid | | Preexisting Conditions: hypothyroidism, cranialsynostosis, hernia repair X 2, bronchopulmanary dysplasia | | CDC 'Split Type': CT911 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | LEDERLE LABORATORIES | 293948 | 1 | IM | LL | | HIBV | LEDERLE PRAXSIS | M090FF | 0 | IM | RL | | OPV | LEDERLE LABORATORIES | 287942 | 0 | PO | | |
| Administered by: Public Purchased by: Public | | Symptoms: Abdominal distension, Apnoea, Cardiac arrest, Infection, Lung disorder, Personality disorder, Pulmonary oedema | | 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 |
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| VAERS ID: | 28497 | Vaccination Date: | 1990-12-02 | | Age: | 0.2 | Onset Date: | 1990-12-02 Days later: 0 | | Gender: | Female | Submitted: | 1991-01-25 | | State: | Maryland | Entered: | 1991-02-28 | |
| Life Threatening Illness? Yes |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? Yes, 1 days | | Extended hospital stay? No |
| Current Illness: none | | Diagnostic Lab Data: anaphylactoid rxn to DPT? Hibtitier? | | Previous Vaccinations: | | Other Medications: none | | Preexisting Conditions: none | | CDC 'Split Type': MD91016 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | LEDERLE LABORATORIES | 285966 | 0 | IM | LL | | HIBV | LEDERLE PRAXSIS | M025FC | 0 | IM | RL | |
| Administered by: Private Purchased by: Private | | Symptoms: Apnoea, Asthenia, Cardiac arrest, Pallor | | Write-up: Approx 3-5 mins /p injection DTP over lt thigh. Hibtiter over rt thigh, baby became pale & paler on lips, then weaker & weaker & stop heart beat & breathing |
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| VAERS ID: | 28812 | Vaccination Date: | 1990-12-18 | | Age: | 0.7 | Onset Date: | 1990-12-18 Days later: 0 | | Gender: | Female | Submitted: | 1991-01-02 | | State: | Pennsylvania | Entered: | 1991-03-04 | |
| Life Threatening Illness? Yes |
| Died? No |
| Disability? Yes |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: BPD, S/P G-Tube placement | | Diagnostic Lab Data: ABG=6.8; PCO2=30; PO2=185; base excess of 25.8; saturated of 97.8%. Lytes p/med NA=141, K=3.1, CO2=2.4, cl=111; Glucose=486; temp 95.4; HR-166 | | Previous Vaccinations: | | Other Medications: Ferinsol, Diuril until 17DEC; Nebs: Ventolin/Mucomyst | | Preexisting Conditions: 25 wk premie w/h/o BPD, Cardiorespiratory arrest; S/P tracheostomy, sepsis, blood trnafusions, subglottis stenosis. | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HIBV | LEDERLE PRAXSIS | M195FD | 0 | IM | RL | | MEA | MERCK & CO. INC. | 1464S | 0 | | LL | |
| Administered by: Private Purchased by: Private | | Symptoms: Apnoea, Cardiac arrest, Cardiac failure | | Write-up: @ 1030PM, monitor went off for heart & respirations; no palpable pulse; appeared to be in asystole. Rec'd Atropine & Epinephrine, bicarb; a second dose of epi & bicarb were also administered @ 10:39, faint fem pulse present; 1 BrS @ 1041 |
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| VAERS ID: | 29348 | Vaccination Date: | 1991-03-08 | | Age: | 0.4 | Onset Date: | 1991-03-10 Days later: 2 | | Gender: | Male | Submitted: | 1991-03-21 | | State: | New Jersey | Entered: | 1991-03-25 | |
| Life Threatening Illness? Yes |
| Died? Yes (date died: 1991-03-12) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? Yes, 2 days | | Extended hospital stay? No |
| Current Illness: Resolving otitis & bronchiolitis; | | Diagnostic Lab Data: Pt to Bridgeton ER & Transferred to Children's Hosp of Phila | | Previous Vaccinations: NA | | Other Medications: Amoxil, Ventolin | | Preexisting Conditions: Clinically well by hx of Physical exam | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | CONNAUGHT LABORATORIES | 0C21045 | 0 | IM | LL | | HIBV | LEDERLE PRAXSIS | M085FP | 0 | IM | RL | | OPV | LEDERLE LABORATORIES | 295950 | 0 | PO | | |
| Administered by: Private Purchased by: Private | | Symptoms: Cardiac arrest, Cyanosis, Hypotonia | | Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp. |
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| VAERS ID: | 29431 | Vaccination Date: | 1991-03-15 | | Age: | 0.2 | Onset Date: | 1991-03-21 Days later: 6 | | Gender: | Male | Submitted: | 1991-03-22 | | State: | Illinois | Entered: | 1991-03-29 | |
| Life Threatening Illness? No |
| Died? Yes (date died: 1991-03-21) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: prior 2-3 wks bronchitis-now over | | Diagnostic Lab Data: autopsy -SIDS | | Previous Vaccinations: none | | Other Medications: none | | Preexisting Conditions: none | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | CONNAUGHT LABORATORIES | 0C21045 | 0 | IM | | | HIBV | LEDERLE PRAXSIS | M660FP | 0 | IM | | | OPV | LEDERLE LABORATORIES | 295948 | 0 | PO | | |
| Administered by: Private Purchased by: Private | | Symptoms: Cardiac arrest, Sudden infant death syndrome | | 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 |
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| VAERS ID: | 29488 | Vaccination Date: | 1991-03-25 | | Age: | 0.2 | Onset Date: | 1991-03-26 Days later: 1 | | Gender: | Female | Submitted: | 1991-03-29 | | State: | Pennsylvania | Entered: | 1991-04-01 | |
| Life Threatening Illness? No |
| Died? Yes (date died: 1991-03-26) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | CONNAUGHT LABORATORIES | 0C21000 | 0 | | LL | | HIBV | LEDERLE PRAXSIS | M560FP | 0 | | RL | |
| Administered by: Private Purchased by: Private | | Symptoms: Cardiac arrest | | Write-up: Cardiac Arrest noted 26MAR @ approx 7PM; Brought to ER-Resuscitation efforts did not help; |
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| VAERS ID: | 30244 | Vaccination Date: | 1990-11-28 | | Age: | 0.3 | Onset Date: | 1990-11-29 Days later: 1 | | Gender: | Female | Submitted: | 0000-00-00 | | State: | Ohio | Entered: | 1991-04-11 | |
| Life Threatening Illness? No |
| Died? Yes (date died: 1990-11-29) |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: Autopsy Report 30NOV90 available-cause of death: SIDS | | Previous Vaccinations: no problems with 1st DTP & OPV | | Other Medications: APAP | | Preexisting Conditions: No chronic illnesses | | CDC 'Split Type': 900216701 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTP | CONNAUGHT LABORATORIES | | 1 | | | | HIBV | LEDERLE PRAXSIS | M205FD | 0 | IM | | | OPV | LEDERLE LABORATORIES | | 1 | PO | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Apnoea, Cardiac arrest, Cyanosis, Sudden infant death syndrome | | Write-up: Morning p/immun, infant was found dead in her crib by babysitter, infant was blue, pulseless & apneic; transported by Ambulance to ER & pronounced dead; Cause-SIDS no sx to immun as fever or irritability, appeared healthy; |
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