|
VAERS ID: |
29348 (history) |
Form: |
Version 1.0 |
Age: |
0.38 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 1991-03-08 |
Onset: | 1991-03-10 |
Days after vaccination: | 2 |
Submitted: |
1991-03-21 |
Days after onset: | 11 |
Entered: |
1991-03-25 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0C21045 / 1 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M085FP / 1 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
295950 / 1 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Cardiac arrest,
Cyanosis,
Hypotonia SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1991-03-12
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient Other Medications: Amoxil, Ventolin Current Illness: Resolving otitis & bronchiolitis; Preexisting Conditions: Clinically well by hx of Physical exam Allergies: Diagnostic Lab Data: Pt to ER & Transferred to another hospital CDC Split Type:
Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp. |
|
VAERS ID: |
29397 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-02-27 |
Onset: | 1991-02-28 |
Days after vaccination: | 1 |
Submitted: |
1991-03-08 |
Days after onset: | 8 |
Entered: |
1991-03-27 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
293948 / 3 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M2053P / 1 |
RL / IM |
Administered by: Public Purchased by: Public Symptoms: Pyrexia,
Rash,
Rhinitis SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: None apparent Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Bloodwork & Urinalysis - normal CDC Split Type: PA9186
Write-up: Fever to 104 27FEB91 & 105 28FEB91; To ER 28FEB91; No apparent infect; Had red blotching on face 1MAR91 p/taking Augmentin was discontinued due to poss allergy; continues to have low grade fever & has clear nasal discharge. |
|
VAERS ID: |
29403 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1990-12-26 |
Onset: | 1991-01-10 |
Days after vaccination: | 15 |
Submitted: |
1991-01-10 |
Days after onset: | 0 |
Entered: |
1991-03-27 |
Days after submission: | 76 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / 1 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M190FD / 1 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
283936 / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-01-10
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Found dead in bed; |
|
VAERS ID: |
29431 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1991-03-15 |
Onset: | 1991-03-21 |
Days after vaccination: | 6 |
Submitted: |
1991-03-22 |
Days after onset: | 1 |
Entered: |
1991-03-29 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0C21045 / 1 |
- / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M660FP / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
295948 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Cardiac arrest,
Sudden infant death syndrome SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-03-21
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: none Current Illness: prior 2-3 wks bronchitis-now over Preexisting Conditions: none Allergies: Diagnostic Lab Data: autopsy -SIDS CDC Split Type:
Write-up: Sudden arrest /p feeding @ baby sitters. DOA 6 days /p vaxs. Baby was fine before, mother went to work. With baby sitter. Autopsy prelim DX-SIDS death, no abnormalities found |
|
VAERS ID: |
29463 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1991-01-17 |
Onset: | 1991-01-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-04-01 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
289963 / 1 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M200FD / 1 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0622D / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Agitation,
Apnoea,
Cardiomegaly,
Cyanosis,
Hernia,
Pallor,
Tachycardia SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-02-02
Days after onset: 16
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: NONE Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur Allergies: Diagnostic Lab Data: CDC Split Type: TX9108
Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor; |
|
VAERS ID: |
29477 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1991-02-21 |
Onset: | 1991-02-21 |
Days after vaccination: | 0 |
Submitted: |
1991-03-08 |
Days after onset: | 15 |
Entered: |
1991-04-01 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
289963 / 1 |
RL / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0626H / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Agitation,
Apnoea,
Hypotonia,
Injection site pain,
Pallor,
Pyrexia,
Sudden infant death syndrome SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: 1991-02-26
Days after onset: 5
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: NONE KNOWN Preexisting Conditions: NONE KNOWN Allergies: Diagnostic Lab Data: possible sids autospy report pending CDC Split Type: TX9122
Write-up: Child mild fever & pain @ inject site; woke up crying; Limp & pale mom not certain if baby was breathing resuscitated poss SIDS; |
|
VAERS ID: |
29485 (history) |
Form: |
Version 1.0 |
Age: |
0.1 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 1991-01-25 |
Onset: | 1991-02-16 |
Days after vaccination: | 22 |
Submitted: |
1991-03-21 |
Days after onset: | 33 |
Entered: |
1991-04-01 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283970 / 1 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M090FF / 1 |
LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0615E / 1 |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-02-16
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: WA91532
Write-up: SIDS |
|
VAERS ID: |
29488 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-03-25 |
Onset: | 1991-03-26 |
Days after vaccination: | 1 |
Submitted: |
1991-03-29 |
Days after onset: | 3 |
Entered: |
1991-04-01 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0C21000 / 1 |
LL / - |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M560FP / 1 |
RL / - |
Administered by: Private Purchased by: Private Symptoms: Cardiac arrest SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-03-26
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: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Cardiac Arrest noted 26MAR @ approx 7PM; Brought to ER-Resuscitation efforts did not help; |
|
VAERS ID: |
29754 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 1991-01-22 |
Onset: | 0000-00-00 |
Submitted: |
1991-02-05 |
Entered: |
1991-04-05 |
Days after submission: | 59 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
289901 / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
283943 / 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: 1991-01-24
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: SC91012
Write-up: infant death-pending autopsy |
|
VAERS ID: |
29756 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 1991-01-08 |
Onset: | 0000-00-00 |
Submitted: |
1991-02-11 |
Entered: |
1991-04-05 |
Days after submission: | 53 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
289901 / 2 |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
283943 / 2 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-02-02
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: none Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: SC91014
Write-up: |
|