|
VAERS ID: |
25769 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1987-09-04 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
175655 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)
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: 9000159.01
Write-up: Claimant under the NCVIA alleges that as a result of DTP on 4SEP87, infant suffered unspecified significant neurological deficiencies. |
|
VAERS ID: |
25780 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-07-26 |
Onset: | 1990-07-28 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-07-29
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 previous seizures in pt. No hx of seizures in parents and/or siblings. Allergies: Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested CDC Split Type: 9001336.01
Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival. |
|
VAERS ID: |
25815 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Alaska |
Vaccinated: | 1990-03-29 |
Onset: | 1990-03-29 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
229974 / 3 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Cyanosis,
Pyrexia SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? 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: Approx 1 hr after DTP started to convulse, turned blue and temp to 104+ taken to clinic and treated with 2X dose of tylenol and sponge baths. Temp held taken to hospital treated in I/C 3hrs retained in hosp overnight. Temp rose again 103. |
|
VAERS ID: |
25860 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1990-07-24 |
Onset: | 1990-07-24 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271914 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Hypotonia,
Leukocytosis,
Somnolence,
Vomiting SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: 18,000 white count with 75 polys, 7 bands and 14 lymphs. Normal urinalysis and stool culture CDC Split Type:
Write-up: Pt vaccinated with DTP experienced twelve hrs of hypotonia with mild vomiting & lethargy. Some loose stools. |
|
VAERS ID: |
25870 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-08-24 |
Onset: | 1990-08-25 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
279947 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
61706 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Pyrexia,
Stupor SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
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 became irritable, body temp 100.f. No vomiting or other symptoms; Fell asleep at 6AM when parents went to wake him for feeding noted to be unresponsive. Paramedics were called brought to ER. |
|
VAERS ID: |
25883 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1990-08-17 |
Onset: | 1990-08-22 |
Days after vaccination: | 5 |
Submitted: |
1990-09-06 |
Days after onset: | 15 |
Entered: |
1990-09-11 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9M01012 / 2 |
- / IM L |
Administered by: Private Purchased by: Private Symptoms: Injection site abscess,
Pain,
Sepsis SMQs:, Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? Yes
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: Allergies: Diagnostic Lab Data: Culture of wound pending CDC Split Type:
Write-up: Pt vaccinated with DTP 5 days later developed a lump in leg which was painful inspite of oral antibiotics became ascess which caused sepsis and was hospitalized. Twin not infected. |
|
VAERS ID: |
25886 (history) |
Form: |
Version 1.0 |
Age: |
0.36 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: | 1990-09-01 |
Onset: | 1990-09-01 |
Days after vaccination: | 0 |
Submitted: |
1990-09-04 |
Days after onset: | 3 |
Entered: |
1990-09-11 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0F11072 / 2 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
268950 / 2 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: TriVI Flor 0.25 vitamins Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: EEG, CTScan, Spinal tap all performed at medical center. CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV developed seizures approx 7.5hrs after vax. No problems after lst set of shots at 2mo. |
|
VAERS ID: |
25888 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-08-23 |
Onset: | 1990-08-23 |
Days after vaccination: | 0 |
Submitted: |
1990-09-05 |
Days after onset: | 13 |
Entered: |
1990-09-11 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271965 / 5 |
RA / - |
Administered by: Private Purchased by: Other Symptoms: Cough,
Urticaria SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Benadryl IM, Decadron IM, given for rash /p vaccine Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP 2 hrs later developed diffuse urticaria; Benadryl IM, Decaoton Im given. Hospitalized 24 hrs later with hives/coughing. |
|
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. |
|