|
VAERS ID: |
25912 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Alaska |
Vaccinated: | 1990-06-08 |
Onset: | 1990-06-08 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B11061 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0605H / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia,
Screaming,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: elevated temperature of 103+, projectile vomitting, continued high pitched crying. Medical examination by treating physician & released. |
|
VAERS ID: |
25913 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: | 1990-01-24 |
Onset: | 1990-01-25 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256960 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Apnoea,
Encephalopathy,
Infection,
Lymphadenopathy,
Pulmonary oedema SMQs:, Cardiac failure (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-01-25
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: See WORM for autopsy report, emergency room reports CDC Split Type:
Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child. |
|
VAERS ID: |
25975 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1990-08-27 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0L11101 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
617M / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV no acute rx reported by mother 48 hrs post immunization |
|
VAERS ID: |
25989 (history) |
Form: |
Version 1.0 |
Age: |
1.8 |
Sex: |
Female |
Location: |
Hawaii |
Vaccinated: | 1989-09-12 |
Onset: | 1989-09-12 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9G101042 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
595 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Abdominal distension,
Agitation,
Atelectasis,
Dyspnoea,
Gastric dilatation SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1989-09-13
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Premature infant w/numerous medical problems. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV developed cardiorespiratory arrest less than 24 hrs after vax. Pt noted to have abd distension and fussiness along with some respiratory distress prior to arrest. Pt was premature infant w/several med problems. |
|
VAERS ID: |
25994 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Wyoming |
Vaccinated: | 1989-12-05 |
Onset: | 1989-12-29 |
Days after vaccination: | 24 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / 4 |
- / L |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2068P / 1 |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
298B1 / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Asphyxia,
Brain oedema,
Immune system disorder,
Infection,
Necrosis,
Pulmonary haemorrhage,
Pulmonary oedema,
Splenomegaly SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Pedizole, Tassi Organdin Current Illness: Otitis, Bronchitis Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy was contradictory /w no conclusions & many signs of Pertussis reactions. CDC Split Type:
Write-up: Casey was given DPT/MMR/OPV while still on anitbiotic Pedizole and tassii organdin for otitis & bronchitis. He appeared happy & well until he died in his sleep. Shots were given on 5DEC89. |
|
VAERS ID: |
26080 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1990-05-18 |
Onset: | 1990-05-19 |
Days after vaccination: | 1 |
Submitted: |
1990-09-18 |
Days after onset: | 122 |
Entered: |
1990-09-24 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB |
DTP270 / 1 |
LL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
268953 / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-05-19
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Hydorcortisone for rash Current Illness: Preexisting Conditions: Heart M gr I/VI (Non significant) Premature (36-37 wks) Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV found to have funny breathing early AM later mother found her not breathing. |
|
VAERS ID: |
26112 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 1990-09-11 |
Onset: | 1990-09-13 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-09-13
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Child immunized with DTP/OPV vaccines on 11SEP90. Sudden Infant Death Syndrome. |
|
VAERS ID: |
26175 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1990-09-05 |
Onset: | 1990-09-11 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-03 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
0F11072 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP 5SEP90 developed SIDS. |
|
VAERS ID: |
26196 (history) |
Form: |
Version 1.0 |
Age: |
0.51 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1990-08-20 |
Onset: | 1990-08-22 |
Days after vaccination: | 2 |
Submitted: |
1990-10-02 |
Days after onset: | 41 |
Entered: |
1990-10-10 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
1211A / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0611E / 2 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Gastrointestinal disorder,
Sudden infant death syndrome,
Weight increased SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-08-22
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: None w/exception of Regurgitation Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr. CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee. |
|
VAERS ID: |
26209 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Unknown |
Location: |
North Carolina |
Vaccinated: | 1990-09-11 |
Onset: | 1990-09-11 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
268910 / 2 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0608E / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-09-13
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy pending - copy of report requested CDC Split Type: 9001603.01
Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration. |
|