|
VAERS ID: |
26336 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-07-26 |
Onset: | 1990-07-29 |
Days after vaccination: | 3 |
Submitted: |
1990-10-23 |
Days after onset: | 86 |
Entered: |
1990-10-25 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0603D / 1 |
MO / PO |
Administered by: Private Purchased by: Private 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: 1990-07-29
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS. CDC Split Type:
Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3. |
|
VAERS ID: |
26483 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Unknown |
Location: |
Connecticut |
Vaccinated: | 1989-07-27 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
244984 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
250939 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Hypertonia,
Insomnia,
Screaming,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-04-18
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: 900157501
Write-up: Pt vaccinated with 1st DTP/OPV on 27Jul89, developed loss of head control, screaming & vomiting, had sleep loss, limbs tense and developed seizures. Hospitalized many times between Sep-Dec89, received DT, condition worsened; Died 18APR90. |
|
VAERS ID: |
26484 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-09-27 |
Onset: | 0000-00-00 |
Submitted: |
1990-10-30 |
Entered: |
1990-11-05 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / 4 |
- / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Agitation,
Apnoea,
Cardiac arrest,
Chills,
Pain,
Pyrexia,
Vasodilatation 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), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (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: 1990-10-06
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/HIB/MMR found apneic in crib on 06OCT90. |
|
VAERS ID: |
26593 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-10-29 |
Onset: | 1990-10-31 |
Days after vaccination: | 2 |
Submitted: |
1990-11-02 |
Days after onset: | 2 |
Entered: |
1990-11-08 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0G11097 / UNK |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-31
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Nystatin Ointment Current Illness: Diaper Rash Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV no adverse effects according to father; Pt was fine the day after immunization. Pt discovered not breathing at 2AM 31OCT. |
|
VAERS ID: |
26603 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1990-10-24 |
Onset: | 1990-10-29 |
Days after vaccination: | 5 |
Submitted: |
1990-11-05 |
Days after onset: | 7 |
Entered: |
1990-11-09 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0A21149 / 2 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0611B / 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: 1990-10-29
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: Proventil Syrup, Terbutaline Current Illness: BPD, Oxygen Dependency Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome. |
|
VAERS ID: |
26694 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1990-09-10 |
Onset: | 0000-00-00 |
Submitted: |
1990-11-16 |
Entered: |
1990-11-21 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285968 / 1 |
- / IM L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
283949 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Depressed level of consciousness,
Encephalitis,
Subarachnoid haemorrhage SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), 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: 1990-10-13
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 CNS Disease Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia Allergies: Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia. CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death. |
|
VAERS ID: |
26714 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-10-15 |
Onset: | 1990-10-21 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285968 / UNK |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0620D / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-21
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV mother put to bed at 10PM for the night. Found pt. at 5AM cold & stiff on 21OCT90. |
|
VAERS ID: |
26715 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-11-07 |
Onset: | 1990-11-10 |
Days after vaccination: | 3 |
Submitted: |
1990-11-20 |
Days after onset: | 10 |
Entered: |
1990-11-26 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256964 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
257190 / 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: 1990-11-10
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 patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsey CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV SIDS presumed as of this date pending coronor''s report. |
|
VAERS ID: |
26799 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 1990-09-24 |
Onset: | 1990-09-26 |
Days after vaccination: | 2 |
Submitted: |
1990-11-20 |
Days after onset: | 55 |
Entered: |
1990-11-27 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
281946 / 1 |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Hydronephrosis SMQs:, Retroperitoneal fibrosis (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-09-26
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: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV child died. Autopsy showed baby had one kidney with chronic type changes, damage, hydronephrosis. |
|
VAERS ID: |
26890 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: | 0000-00-00 |
Onset: | 1990-01-25 |
Submitted: |
0000-00-00 |
Entered: |
1990-12-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256960 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
256930 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pneumonia,
Sudden infant death syndrome SMQs:, 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: 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: Post mortem - "slight pneumonia" CDC Split Type:
Write-up: Pt vax with DTP/OPV was doing well on 25JAN90 taken to sitter. Found dead in crib in afternoon. |
|