|
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: |
26007 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-09-06 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
OB11061 / UNK |
- / SC |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
14995 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0612H / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Nuchal rigidity,
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? 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: 10SEP90 SPINAL TAP 17 WBC 1 RBC PR 20 PO 4 CULTURES - NEGATIVE CDC Split Type:
Write-up: PT VACCINATED WITH DTP/MMR/OPV DEVELOPED FEVER, STIFF NECK |
|
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: |
26083 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1990-03-07 |
Onset: | 1990-03-07 |
Days after vaccination: | 0 |
Submitted: |
1990-09-11 |
Days after onset: | 187 |
Entered: |
1990-09-24 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9B11033 / 1 |
- / IM L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
259948 / 1 |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Gaze palsy,
Hypotonia,
Pyrexia,
Screaming,
Tremor SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Ocular motility disorders (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? Yes 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: Nasal congestion Allergies: Diagnostic Lab Data: HGB 7.7, g+stools, later transferred for evaluation of GI bleeding. CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV developed fever 101.8, crying followed by body shaking for 3; eyes rolled back few seconds of limpness then returned to crying. Hosp for evaluation, seizure. |
|
VAERS ID: |
26086 (history) |
Form: |
Version 1.0 |
Age: |
0.8 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 1990-08-24 |
Onset: | 1990-08-25 |
Days after vaccination: | 1 |
Submitted: |
1990-09-19 |
Days after onset: | 25 |
Entered: |
1990-09-24 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
OF11073 / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0614H / UNK |
MO / PO |
Administered by: Military Purchased by: Military Symptoms: Febrile convulsion SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
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: Allergies: Diagnostic Lab Data: CT of head normal CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV developed status epilepticus within 18 hrs of lst DTP associated with fever. |
|
VAERS ID: |
26102 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 1990-08-21 |
Onset: | 1990-09-03 |
Days after vaccination: | 13 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283913 / 3 |
RL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
M66FB / 1 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
12925 / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277942 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Agitation,
Confusional state,
Gait disturbance,
Skin discolouration,
Somnolence,
Vomiting SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk Current Illness: none WIC recert. Preexisting Conditions: 10/89 Sizemore, PA no known allergies Allergies: Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90 CDC Split Type:
Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands |
|
VAERS ID: |
26110 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-05-09 |
Onset: | 1990-05-09 |
Days after vaccination: | 0 |
Submitted: |
1990-09-20 |
Days after onset: | 134 |
Entered: |
1990-09-26 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B11061 / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
06080 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Cyanosis,
Hypokinesia,
Hypotonia,
Pallor SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? 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 hypotonic, hyporesponsive, pale, bluish. |
|
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: |
26117 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Unknown |
Location: |
Iowa |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / 3 |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Cough,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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: 9001515.01
Write-up: At 2 mos old, child received DTP, 2 days later developed a Staccato cough which worsened & progressed to emesis, hospitalized & treated w/erythromycin & cromolyn, no bacterial isolation. At 4 mos old received DTP. See WORM for more Info. |
|