|
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: |
25550 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1989-08-18 |
Onset: | 1989-08-18 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
0584E / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Convulsion,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: 3 min febrile convulsion in assoc./w fever to 105 F within 12 hrs of receving DTP. Was evaluated @ Hospital ER- full septic W/U; neg C.P.(/), all results neg. observed overnight- no sequele |
|
VAERS ID: |
25553 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9J01114 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Adrenal cortex necrosis,
Adrenal haemorrhage,
Lung disorder,
Neoplasm,
Petechiae,
Pulmonary oedema,
Stupor,
Ventricular fibrillation SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: none Current Illness: routine well baby checkup given Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM. |
|
VAERS ID: |
25556 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1989-10-20 |
Onset: | 1989-10-25 |
Days after vaccination: | 5 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
42622/1644R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sepsis SMQs:, Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1989-10-25
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: no relevant history Preexisting Conditions: Allergies: Diagnostic Lab Data: autopsy-strep sepsis, The physician & autopsy pathologist felt that the pt''s dealth was not related to vaccination. CDC Split Type: WAES89100782
Write-up: MD reported pt initially vac. w/ MMR live at 15 mo''s was vac. w/ booster MMR on 10-20-89 along w/ DTP. Pt died 10-25-89. Autopsy = overwhelming strep. sepsis. MD and autopsy pathologist felt pt death not related to vaccination. |
|
VAERS ID: |
25619 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-07-17 |
Onset: | 1990-07-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
262913 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Convulsion,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: LP- 70- RBC, 0- WBC, 35- protein, 75- glucose, Culture no growth, CBC- WBC 20,300, Het- 33, PHS- normal, blood culture no grwoth, EEG- normal CDC Split Type:
Write-up: 6 hrs p/ 3rd DPT generalized tonic clonic seizure approx. 45 min. assoc. /w fever. Taken to hospital & then to MD for evaluation. |
|
VAERS ID: |
25627 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1990-05-11 |
Onset: | 1990-05-18 |
Days after vaccination: | 7 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB |
DTP270 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Hemiplegia,
Paralysis SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 9033
Write-up: Pt vaccinated w/DTP and OPV experienced unilateral cranial nerve palsy. |
|
VAERS ID: |
25648 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1989-11-17 |
Onset: | 1989-11-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Convulsion,
Pallor,
Pyrexia,
Stupor,
Visual disturbance SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: no prior history on rxn''s Allergies: Diagnostic Lab Data: CDC Split Type: 8902745.01
Write-up: Pt received ORIMUNE, DTP, PROHIBIT and was not focusing, in a daze, pale but not rigidly seizing. Seen in ER was febrile. Hospitalized for observation & placed on monitor. MD impression is seizure. |
|
VAERS ID: |
25664 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Female |
Location: |
Delaware |
Vaccinated: | 1990-07-18 |
Onset: | 1990-07-19 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0F11081 / 3 |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Convulsion,
Hypokinesia,
Hypotonia,
Muscle twitching,
Pallor,
Pyrexia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Premie 32 wk gestation Allergies: Diagnostic Lab Data: Normal EEG CDC Split Type:
Write-up: Pt received 3rd DTP at noon 18-JUL-90 approx 24 hrs later temp 103, episode of poor color, staring expression, hypotonia. Twitching & color change cleared in seconds, hypotonia & expressionless face for minutes. More details see WORM. |
|
VAERS ID: |
25683 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1990-06-29 |
Onset: | 1990-07-02 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271911 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0603F / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-07-02
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: hx of infantile apnea syndrome Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor. |
|
VAERS ID: |
25691 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1990-06-04 |
Onset: | 1990-06-05 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259958 / UNK |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
598E3936 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Injection site hypersensitivity,
Injection site oedema,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: Lumbar puncture WNL CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90 |
|