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Found 402 cases where Vaccine is MMR and Patient Died

Case Details (Sorted by VAERS ID)

VAERS ID: 25010 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Foreign  
Vaccinated:1989-10-29
Onset:1989-12-01
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. A2223P / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Bronchitis
SMQs:

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: Promethanzine HCL given 21Dec89-21Dec89
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Dianostic test - Autopsy, Date Dec89 , comment - Streptococcal tracheobronchitis
CDC Split Type: WAES90060362

Write-up: 17 mon. male, received 29Oct89 MMR vaccine 1 dose. 21Dec89 received therapy w/ Promethazine HCL, HS. 22Dec89 infant found dead. Post mortem revealed acute Streptococcal tracheobronchitis.


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:, Agranulocytosis (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: 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: 26224 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Missouri  
Vaccinated:1990-07-31
Onset:1990-08-05
   Days after vaccination:5
Submitted: 1990-10-06
   Days after onset:62
Entered: 1990-10-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH - / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Face oedema, Hypersensitivity, Oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-08-11
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hypoglycemic of Newborn; R/O Sepc as newborn
Allergies:
Diagnostic Lab Data: Chest X-Ray Neg; All lab work neg; SGOT = 200; NA 123; EKG neg; ECHO heart neg
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed puffy eyes seen in office dx allergy given Benadryl; Seen 8AUG some vomiting, 9AUG admitted more puffiness & edematous See WORM for more details.


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: 28906 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1989-12-08
Onset:1989-12-27
   Days after vaccination:19
Submitted: 1991-02-27
   Days after onset:427
Entered: 1991-03-08
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471P / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-12-27
   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: Finlepsen (Carbamazepine)
Current Illness: NONE
Preexisting Conditions: Epilepsy listed in autopsy as basic cause of death.
Allergies:
Diagnostic Lab Data: pt did not seek medical attention. No tests performed p/vax was administered.
CDC Split Type:

Write-up: Five days p/MMR vax was administered, pt experienced recurring headaches which continued until her death.


VAERS ID: 29978 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-02-14
Onset:1991-03-10
   Days after vaccination:24
Submitted: 1991-04-16
   Days after onset:36
Entered: 1991-04-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rhinitis, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-10
   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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC Split Type:

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


VAERS ID: 34373 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:1991-04-17
Onset:1991-04-20
   Days after vaccination:3
Submitted: 1991-04-22
   Days after onset:2
Entered: 1991-08-29
   Days after submission:129
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-21
   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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC Split Type: NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


VAERS ID: 34471 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Female  
Location: Georgia  
Vaccinated:1991-08-13
Onset:1991-08-14
   Days after vaccination:1
Submitted: 1991-08-23
   Days after onset:9
Entered: 1991-09-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Acidosis, Convulsion, Haemorrhage, Marrow hyperplasia, Necrosis, Petechiae, Splenomegaly, Thrombotic thrombocytopenic purpura
SMQs:, Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Renovascular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-08-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: few petechia on back, abd, legs
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91239

Write-up: Mom called 19AUG91 reporting pt started w/diarrhea, fever? (no thermometer), sleeping a lot on 14AUG91; rash on 18AUG91 & was advised to seek med eval that day; Did not go for care until pt collapsed @ home p/MN; Taken to ER, where pt died;


VAERS ID: 35477 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-26
Onset:1991-09-26
   Days after vaccination:0
Submitted: 1991-09-30
   Days after onset:4
Entered: 1991-10-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-26
   Days after onset: 0
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: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC Split Type: LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


VAERS ID: 35663 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1991-09-10
Onset:1991-09-20
   Days after vaccination:10
Submitted: 1991-09-24
   Days after onset:4
Entered: 1991-10-21
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Meningitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-21
   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:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC Split Type: LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


VAERS ID: 36455 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Texas  
Vaccinated:1991-10-24
Onset:1991-10-26
   Days after vaccination:2
Submitted: 1991-11-12
   Days after onset:17
Entered: 1991-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-29
   Days after onset: 3
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


VAERS ID: 37837 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1991-07-12
Onset:1991-07-30
   Days after vaccination:18
Submitted: 1991-12-05
   Days after onset:128
Entered: 1991-12-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, 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 (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-30
   Days after onset: 0
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC Split Type:

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


VAERS ID: 37898 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1991-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Headache, Meningitis, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: CSF-Microscopy, unremarkable; Post mortem investigations subsequently revealed evidence of past mumps infection; Only virus isolated was an echovirus type 25 from nasopharyngeal secretions; MD felt pts meningoencephalitis & death not re:vax
CDC Split Type: WAES91120207

Write-up: 10 days following vax pt devel vomiting & h/a; 72 hrs following these sx, pt was hospitalized; On admission pt was afebrile & semiconscious; 48 hrs following hospitalization pt died; Post mortem investigations past mumps infection;


VAERS ID: 38811 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Texas  
Vaccinated:1989-12-19
Onset:1989-12-29
   Days after vaccination:10
Submitted: 1991-08-01
   Days after onset:579
Entered: 1992-01-14
   Days after submission:166
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0818P / 1 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Encephalitis, Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), 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? Yes
   Date died: 1989-12-31
   Days after onset: 2
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: UNK~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 days p/vax had sz, @ hosp;


VAERS ID: 39041 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1992-01-04
Onset:1992-01-05
   Days after vaccination:1
Submitted: 1992-01-13
   Days after onset:8
Entered: 1992-01-27
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

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: 1992-01-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


VAERS ID: 39360 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Unknown  
Location: Foreign  
Vaccinated:1990-01-31
Onset:1990-01-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-31
   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: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC Split Type: WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


VAERS ID: 41374 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: New Hampshire  
Vaccinated:1992-02-26
Onset:1992-03-19
   Days after vaccination:22
Submitted: 1992-03-26
   Days after onset:7
Entered: 1992-04-22
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-21
   Days after onset: 2
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: unk
CDC Split Type: NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


VAERS ID: 41711 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Louisiana  
Vaccinated:1992-04-01
Onset:1992-04-01
   Days after vaccination:0
Submitted: 1992-04-13
   Days after onset:11
Entered: 1992-05-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-01
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC Split Type: LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


VAERS ID: 42039 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Texas  
Vaccinated:1992-02-25
Onset:1992-03-07
   Days after vaccination:11
Submitted: 1992-05-11
   Days after onset:64
Entered: 1992-05-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-07
   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:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


VAERS ID: 43166 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:1992-05-08
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K4709 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure, Endocarditis, Infection
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-13
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: UNK
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: Autopsy planned;
CDC Split Type: WAES92060551

Write-up: Pt recvd MMR vax on 8MAY92 & devel bacterial endocarditis complicated by heart failure & was hospitalized; 13JUN92 pt died due to bacterial endocarditis complicated by heart failure; autopsy is planned;


VAERS ID: 43261 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Arizona  
Vaccinated:1991-08-28
Onset:1991-09-06
   Days after vaccination:9
Submitted: 1992-06-04
   Days after onset:272
Entered: 1992-06-30
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC Split Type:

Write-up:


VAERS ID: 43310 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Texas  
Vaccinated:1992-01-07
Onset:1992-01-08
   Days after vaccination:1
Submitted: 1992-06-12
   Days after onset:155
Entered: 1992-07-02
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160HF / 2 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0983T / 1 - / IM L

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Diarrhoea, Encephalopathy, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple tests @ hosp;
CDC Split Type:

Write-up: Pt recvd MMR/HIB 7JAN92 & seen in clinic w/fever, vomiting, diarrhea 10JAN92; 13JAN92 was much improved; seen in clinic 6MAR92 w/ataxia, listlessness adm to hos 17MAR92 dx leukoencephalopathy


VAERS ID: 43712 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Oregon  
Vaccinated:1992-05-19
Onset:1992-06-10
   Days after vaccination:22
Submitted: 1992-06-16
   Days after onset:6
Entered: 1992-07-24
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1712S / 1 - / SC

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Infection, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp elevated temp @ 16 1/2 mos w/DTP/OPV/HIB/PPD #1 dose;~ ()~~~In patient
Other Medications: PPD by Connaught lot# 233121 29APR91; polyviflor; tums;
Current Illness: afebrile, chronic vegetative state
Preexisting Conditions: abruptio placenta-birth asphyxia-persistent vegetative state microcephaly, temp instability, acute renal tubular necrosis;
Allergies:
Diagnostic Lab Data: G-tube culture/purulent dr/gm stain no bacteria; prelim results WBC''s +1 gm neg bacilli +1; gm pos cocci +1;
CDC Split Type: OR9238

Write-up: 10JUN92 230PM resp distress, color bluish, temp elevated; 02 placed, resp tx given, suctioned, APAP given for temp sudafed given no effect; 730PM resp & cardiac arrest, no code;


VAERS ID: 47460 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Montana  
Vaccinated:1992-10-13
Onset:1992-10-27
   Days after vaccination:14
Submitted: 1992-11-10
   Days after onset:14
Entered: 1992-11-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322915 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0055T / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Infection, Meningitis, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-27
   Days after onset: 0
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: URI-no temp
Preexisting Conditions: normal
Allergies:
Diagnostic Lab Data: lab tests completed @ hosp 27OCT92;
CDC Split Type: MT92027

Write-up: pt was admitted to hosp on 27OCT92 for pneumonia began to devel resp problems & was transferred to another hosp on 27OCT92; dx Haemophilus Influenza meningitis & died 27OCT92;


VAERS ID: 47526 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Wisconsin  
Vaccinated:1992-05-07
Onset:1992-05-09
   Days after vaccination:2
Submitted: 1992-07-07
   Days after onset:59
Entered: 1992-11-30
   Days after submission:146
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M665HH / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703T / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Asthenia, Diarrhoea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-05-21
   Days after onset: 12
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
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: mom knows lab work done-unsure what tests;
CDC Split Type: WI92054

Write-up: diarrhea, vomiting; rash tha came & went around neck & diaper area; tired; no blood in stool; poor appetite; no headache; no seizures; seen by MD:


VAERS ID: 47663 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-08-20
Onset:1992-08-31
   Days after vaccination:11
Submitted: 1992-09-30
   Days after onset:30
Entered: 1992-12-03
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 330910 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0011V / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 329960 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Coma, Convulsion, Headache, Neck pain, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), 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), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: spinal tap, blood culture, EEG, x-rays, Brain scan;
CDC Split Type: MS9251

Write-up: 31AUG92 pt spiked t103 & c/o h/a & sore neck; was taken to hosp & treated w/PCN & phenergan & sent home; 1SEP92 pt had seizure & was taken to hosp adm to hosp 1SEP92; pt has been in coma since 1SEP92;


VAERS ID: 50678 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Oklahoma  
Vaccinated:1993-02-11
Onset:1993-02-18
   Days after vaccination:7
Submitted: 1993-03-04
   Days after onset:14
Entered: 1993-03-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0804V / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0665F / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Dyspnoea, Hepatic steatosis, Pulmonary oedema, Pyrexia, Red blood cell abnormality, Vomiting
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-02-18
   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: NONE
Current Illness: rash & URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OK936

Write-up: collapsed on 18FEB93-no prior sx;


VAERS ID: 51238 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Foreign  
Vaccinated:1992-05-19
Onset:1992-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1993-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 46882 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypotension, Infection, Meningitis, Muscle twitching, Mydriasis, Respiratory disorder, Sepsis, Tachycardia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Noninfectious meningitis (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
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: unk
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES92125124

Write-up: Pt recvd vax MAY92 & on 22MAY92 pt temp rose to 104 & vomited 4 times in 3 hrs; hydrated & chest clear; pt admited to hosp where died of meningococcal meningitis;


VAERS ID: 51544 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Florida  
Vaccinated:1993-03-12
Onset:1993-03-12
   Days after vaccination:0
Submitted: 1993-03-31
   Days after onset:19
Entered: 1993-04-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985V / UNK - / SC

Administered by: Private       Purchased by: Other
Symptoms: Anorexia
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-03-13
   Days after onset: 1
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: premature infant
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93030817

Write-up: Pt recvd vax on 12MAR93 & exp loss of appetite & was presented back to MD office; MD felt child was fine; 13MAR92 the pt was found dead;


VAERS ID: 53621 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: New York  
Vaccinated:1982-02-09
Onset:1982-02-23
   Days after vaccination:14
Submitted: 1993-06-04
   Days after onset:4118
Entered: 1993-06-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Brain oedema, Cardiac arrest, Dehydration, Diabetic coma, Faecaloma, Infection, Ketosis, Pancreatic disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1982-04-08
   Days after onset: 44
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: common cold; Roseola;
Allergies:
Diagnostic Lab Data: 8APR82 Autopsy-death determined to be diabetic ketoacidosis & coma; pancreas found to be virus infected;
CDC Split Type: WAES93050798

Write-up: pt recvd vax 9FEB82 & on 23FEB82 devel diabetic sx: excessive urination & thirst; parents did not recognize sx until pt went into coma 7APR92 following day pt died; pt was dehydrated w/early fecal impaction, pancreatic edema; cerebral edema


VAERS ID: 54070 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted: 1993-01-28
Entered: 1993-06-21
   Days after submission:143
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
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: death being investigated by ME:
CDC Split Type: WI93038

Write-up: pt was found dead in bed; no other sx were noted;


VAERS ID: 56638 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:1993-08-20
Onset:1993-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Brain oedema, Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC Split Type:

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


VAERS ID: 57571 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted: 1993-09-28
Entered: 1993-11-22
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-14
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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


VAERS ID: 57599 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:1993-10-06
Onset:1993-10-12
   Days after vaccination:6
Submitted: 1993-10-13
   Days after onset:1
Entered: 1993-11-22
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Atrial septal defect, Brain oedema, Hepatocellular damage, Infection, Neuropathy, Pulmonary oedema, Somnolence
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-12
   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: Pediacare
Current Illness: nasal congestion
Preexisting Conditions: questionable failure to thrive dec gray matter & mylinization;
Allergies:
Diagnostic Lab Data: preliminary autopsy results cerebral edema & lung congested;
CDC Split Type: NYS93072

Write-up: pt seen by ER on 11OCT93 for inc lethargy & sl temp 101; dec & appetite;


VAERS ID: 57905 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Michigan  
Vaccinated:1993-06-14
Onset:1993-06-15
   Days after vaccination:1
Submitted: 1993-09-20
   Days after onset:97
Entered: 1993-12-06
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


VAERS ID: 58232 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:1991-01-01
Submitted: 1993-12-10
   Days after onset:1074
Entered: 1993-12-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiac failure, Cardiomyopathy, Dyspnoea, Electrocardiogram abnormal, Hyperventilation, Infection, Myocarditis, Pleural effusion
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-10-10
   Days after onset: 281
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical hx: imperforate anus;
Allergies:
Diagnostic Lab Data: Chest x-ray JAN91: cardiomegaly/pleural effusion; ECG JAN91: cardiomegaly; ECG 18JAN91: voltage & T wave improvement; 13FEB91 ECG: extremely low voltage;
CDC Split Type: WAES93111107

Write-up: Pt recvd vax in FEB91 & devel cardiomyopathy & myocarditis; pt underwent a heart transplant; however, it was unsuccessful; 10OCT91 pt died;


VAERS ID: 58817 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Female  
Location: Montana  
Vaccinated:1993-10-15
Onset:1993-10-25
   Days after vaccination:10
Submitted: 1993-12-27
   Days after onset:63
Entered: 1994-01-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / UNK - / IM A
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1043W / UNK - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0961W / UNK - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686B / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden death; atuopsy report-cause of death remains undetermined; The poss of a sudden arrhythmia based on a morphologic abnormality of the conducting system of the heart will be investigated further;


VAERS ID: 60732 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-03-09
Entered: 1994-03-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Hepatic function abnormal, Hepatic necrosis, Hepatic steatosis, Hepatomegaly, Infection, Leukopenia, Pneumonia
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haematopoietic leukopenia (narrow), Lack of efficacy/effect (narrow), Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Otitis media; Eczema; Pneumonia; fever; prematurity; Immunologic disorder;
Allergies:
Diagnostic Lab Data: Blood teste neg; Urine screen neg; Serum transaminases elevated; serum bilirubin elevated; liver biopsy panzonal fatty change, cholestas; bone marrow exam grew measles virus; autopsy multinucleated cells; autospy lymphocyte depletion;
CDC Split Type: WAES94020934

Write-up: Pt recvd vax & exp fever of 38.9, diarrhea, scaling erythematous rash, oral candidiasis & an enlarged liver 98cm); lab results revealed elevated alkaline phosphatase, gamma-glutamyl transferase, aspartate aminitransferase;


VAERS ID: 61523 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Female  
Location: Foreign  
Vaccinated:1993-08-24
Onset:1993-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

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: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


VAERS ID: 62484 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Foreign  
Vaccinated:1994-04-07
Onset:1994-04-15
   Days after vaccination:8
Submitted: 1994-05-06
   Days after onset:21
Entered: 1994-05-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1582W / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Infection, Lung disorder, Lymphadenopathy, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: no relevant history;
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES94045034

Write-up: Pt recvd vax 7APR94 & 15APR94 the pt died suddenly; An autopsy is to be carried out to determine COD; Addtl info has been requested;


VAERS ID: 63044 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: New York  
Vaccinated:1994-05-03
Onset:1994-05-06
   Days after vaccination:3
Submitted: 1994-05-16
   Days after onset:10
Entered: 1994-05-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0178A / UNK GM / -

Administered by: Private       Purchased by: Private
Symptoms: Brain oedema, Conjunctivitis, Dehydration, Encephalopathy, Otitis media, Pyrexia, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-05-07
   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: pvt
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-brain specimens sent for viral studies;
CDC Split Type:

Write-up: 2 days following inject pt devel OM & conjunctivitis w/fever; treated w/Augmentin; devel vomiting & dehydration 3 days p/vax; unexputed death autopsy showed brain edema;


VAERS ID: 64421 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Male  
Location: Foreign  
Vaccinated:1994-06-06
Onset:1994-06-09
   Days after vaccination:3
Submitted: 1994-06-27
   Days after onset:18
Entered: 1994-07-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-06-10
   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:
Allergies:
Diagnostic Lab Data: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC Split Type: WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


VAERS ID: 64763 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:1994-06-09
Onset:1994-06-13
   Days after vaccination:4
Submitted: 1994-07-13
   Days after onset:30
Entered: 1994-07-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Nuchal rigidity, Respiratory disorder, Thrombocytopenia
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-20
   Days after onset: 7
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:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC Split Type: WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


VAERS ID: 66001 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1993-03-09
Onset:1993-03-22
   Days after vaccination:13
Submitted: 1994-08-13
   Days after onset:508
Entered: 1994-08-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41060 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1186V / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0658L12 / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Dehydration, Hepatocellular damage, Infection, Jaundice, Lymphocytosis, Pyrexia, Spleen disorder
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-06-11
   Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 60 days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergic to sulfa other than that healthy
Allergies:
Diagnostic Lab Data: MD felt pt had hepatitis, but test came back neg, it was determined pt had mono from EBV
CDC Split Type:

Write-up: fever, vomiting, dehydration, jaundice, tired, blood problems, liver & spleen problems went on for over 2 months;


VAERS ID: 66768 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Alabama  
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted: 1994-08-05
Entered: 1994-09-19
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Azotaemia, Brain oedema, Clostridium colitis, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia
SMQs:, Acute renal failure (narrow), Haemolytic disorders (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Pseudomembranous colitis (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-08-02
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC Split Type: AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


VAERS ID: 67195 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Foreign  
Vaccinated:1994-08-11
Onset:1994-08-11
   Days after vaccination:0
Submitted: 1994-10-03
   Days after onset:53
Entered: 1994-10-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypersensitivity (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: none;
Current Illness: none;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none;
CDC Split Type: WAES94090729

Write-up: pt recvd vax & in the eve exp 1 episode of wheezing; dx as respiratory distress; pt found dead at 3am morning of 12aug94; cause of death determined to be sids;


VAERS ID: 67562 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Iowa  
Vaccinated:1994-09-30
Onset:1994-10-02
   Days after vaccination:2
Submitted: 1994-10-18
   Days after onset:16
Entered: 1994-10-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0830A / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cerebral haemorrhage, Coagulopathy, Convulsion, Haemorrhage, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data: nl platelets ct; no purpura;
CDC Split Type:

Write-up: pt recvd vax at checkup; onset of vomiting 2 days after vax; v sporadic, then freq til onset of focal sz 2 days later; ct scan showed cerebral hemorrhage; analysis showed DIC-like picture; cont cns bleeding, eventual death; no post mortem;


VAERS ID: 68431 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Illinois  
Vaccinated:1994-10-31
Onset:1994-11-01
   Days after vaccination:1
Submitted: 1994-11-04
   Days after onset:3
Entered: 1994-11-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-01
   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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC Split Type:

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


VAERS ID: 68523 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1994-11-14
Entered: 1994-11-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Coordination abnormal, Electroencephalogram abnormal, Encephalitis, Infection, Personality disorder, Pneumonia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
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: febrile illness; rash
Allergies:
Diagnostic Lab Data: MRI inc signal, corona radiata; EEG abn; MRI progression, abnormalities;
CDC Split Type: WAES94110237

Write-up: pt recvd vax & 6 months following vax pt became clumsy, & had generalized myoclonic szs each day; brain MRI scan revealed areas of inc signal in the corona radiata; EEG was abn; dec in social skills & use of language; stuporous; pneumonia;


VAERS ID: 68886 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Illinois  
Vaccinated:1993-01-06
Onset:1993-01-07
   Days after vaccination:1
Submitted: 1994-11-07
   Days after onset:669
Entered: 1994-11-22
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

Administered by: Public       Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (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? Yes
   Date died: 1993-06-01
   Days after onset: 144
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC Split Type: IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


VAERS ID: 70595 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Foreign  
Vaccinated:1994-10-25
Onset:1994-11-05
   Days after vaccination:11
Submitted: 1995-01-10
   Days after onset:66
Entered: 1995-01-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Adrenal haemorrhage, Adrenal insufficiency, Dyspnoea, Infection, Petechiae, Sepsis, Shock, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-11-06
   Days after onset: 1
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: no relevant hx
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES94120828

Write-up: pt recvd vax;5nov94 suddenly devel fever 39.8C,tachycardia,v,petechial hemorrhages;pt adm to hosp;on 6nov94 died;COD was septic multiorgan failure;there was a suspiscion of meningococcal toxemia w/ picture of Waterhouse-Friedr synd;


VAERS ID: 71851 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:1995-01-25
Onset:1995-01-27
   Days after vaccination:2
Submitted: 1995-01-30
   Days after onset:3
Entered: 1995-03-01
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-27
   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: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


VAERS ID: 72450 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Foreign  
Vaccinated:1995-02-20
Onset:1995-02-21
   Days after vaccination:1
Submitted: 1995-03-23
   Days after onset:30
Entered: 1995-03-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Bronchitis, Cough, Infection, Pneumonia, Pyrexia, Sepsis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-02-22
   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: cough syrup
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: blood test-streptococcus pneumonia;
CDC Split Type: WAES95030780

Write-up: pt recvd vax & had a sl cough & cough medicine was prescribed; On 21FEB95 & exp fever of 38.6 to 38.7; 22FEB95 woke in the morning crying; went to sleep again 1hr later found dead; tracheobronchitis; streptococcus pneumonia, type 10A found


VAERS ID: 73024 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1995-03-17
Onset:1995-03-24
   Days after vaccination:7
Submitted: 1995-03-28
   Days after onset:4
Entered: 1995-04-07
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-03-24
   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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


VAERS ID: 74166 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Indiana  
Vaccinated:1995-05-03
Onset:1995-05-04
   Days after vaccination:1
Submitted: 1995-05-15
   Days after onset:11
Entered: 1995-05-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC Split Type: WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


VAERS ID: 74801 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Foreign  
Vaccinated:1993-07-21
Onset:1993-08-05
   Days after vaccination:15
Submitted: 1995-06-08
   Days after onset:672
Entered: 1995-06-13
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Asthenia, Cyanosis, Infection, Meningitis, Pyrexia, Rhinitis, Sepsis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-05
   Days after onset: 0
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: unk
Current Illness:
Preexisting Conditions: gastroenteritis
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95051125

Write-up: Pt recv vax 21JUL93 & was vax w/MMR; pt devel meningococcal sepsis on 5AUG93 & was hospitalized; 05AUG93 pt died; The COD was meningococcal septicemia; addtl details are being requested;


VAERS ID: 75061 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1995-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0834R / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

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: No relevant data;
CDC Split Type: WAES94041158

Write-up: pt recv vax in winter of 1989 & 1 day later died; mail requesting f/u fr reporter was returned marked "moved-left no address-unable to forward-return to sender".


VAERS ID: 75498 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: New York  
Vaccinated:1995-02-10
Onset:1995-02-21
   Days after vaccination:11
Submitted: 1995-06-26
   Days after onset:124
Entered: 1995-06-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0968A / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Anaemia, Bone marrow depression, Encephalitis, Leukopenia, Mouth ulceration, Pyrexia, Thrombocytopenia, Visual disturbance
SMQs:, Severe cutaneous adverse reactions (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
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: PPD from lederle given 10FEB95
Current Illness: Roseola?
Preexisting Conditions: innocent heart neg; dubonitz synd, SGA/IUGR;
Allergies:
Diagnostic Lab Data: CBC: WBC =.8; Het=25; Plt=22k; PT 13; PTT 37;
CDC Split Type:

Write-up: pt recv vax; T 105.4; encephalitis, bone marrow suppression, visual disturbance, mouth sores;


VAERS ID: 75867 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-05-19
Onset:1995-05-21
   Days after vaccination:2
Submitted: 1995-06-23
   Days after onset:33
Entered: 1995-07-13
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-21
   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: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC Split Type: PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


VAERS ID: 76575 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Foreign  
Vaccinated:1995-06-27
Onset:1995-07-02
   Days after vaccination:5
Submitted: 1995-08-02
   Days after onset:31
Entered: 1995-08-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coagulopathy, Hepatic cirrhosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage laboratory terms (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-07-04
   Days after onset: 2
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: cirrhosis, liver; alpha-1 antitrypsin deficiency
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95071678

Write-up: pt recv vax & on 02JUL95 pt hospitalized & died on 04JUL95 disseminated intravascular coagulation;


VAERS ID: 76587 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Florida  
Vaccinated:1995-03-08
Onset:1995-04-05
   Days after vaccination:28
Submitted: 1995-08-08
   Days after onset:125
Entered: 1995-08-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0455W / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0735P / 2 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Hepatomegaly, Neoplasm malignant, Pain, Pyrexia, Splenomegaly, Vomiting, Weight decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-06-19
   Days after onset: 75
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: lab work done, positive for strep
CDC Split Type:

Write-up: pt recv vax;about 4-5 wk p/ vax pt c/o pain in her rt side,not better,hosp,dx w/ cancer;mom thinks vax triggered cancer;c/o pharyngitis,v,dec appetite;significant weight dec;pain abd;T 99.3;back pain;pt died from renal cell carcinoma;


VAERS ID: 76687 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Minnesota  
Vaccinated:1991-07-24
Onset:1991-08-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-03
   Days after onset: 733
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: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, rash , red throat;


VAERS ID: 76787 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Unknown  
Location: Foreign  
Vaccinated:1995-05-10
Onset:1995-06-29
   Days after vaccination:50
Submitted: 1995-08-18
   Days after onset:50
Entered: 1995-08-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Infection, Meningism, Meningitis, Neoplasm, Strabismus, Vomiting
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (narrow), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? Yes
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: no relevant data
CDC Split Type: WAES95080780

Write-up: pt recv vax;on 29jun95 pt exp v;10 days later,pt devel strabismus & meningism;pt was hosp on 8jul95 & subsequently died;COD not provided;30JAN96-f/u indicates Coxsackie-B viral infect caused pt''s encephalitis,dx w/ medullablastoma of men


VAERS ID: 78670 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1995-05-24
Onset:1995-06-06
   Days after vaccination:13
Submitted: 1995-10-31
   Days after onset:147
Entered: 1995-11-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0640A / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0552A / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Convulsion, Delirium, Encephalopathy, Pallor, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-06-10
   Days after onset: 4
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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/receiving vax feverish & very pale-took pt for blood work 4 days prior to death-due to paleish face;went into a sx disorder & went into cardiac arrest was pronounced dead on arrival;


VAERS ID: 78939 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Kansas  
Vaccinated:1995-05-12
Onset:1995-05-19
   Days after vaccination:7
Submitted: 1995-11-07
   Days after onset:172
Entered: 1995-11-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LL / -

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-05-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


VAERS ID: 80949 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1996-01-11
Onset:1996-01-15
   Days after vaccination:4
Submitted: 1996-01-15
   Days after onset:0
Entered: 1996-01-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-01-15
   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: EMTS w/ lividity & rigor
CDC Split Type:

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


VAERS ID: 82736 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1995-02-15
Entered: 1996-02-20
   Days after submission:370
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Clostridium colitis, Infection, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (narrow)

Life Threatening? Yes
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: no relevant data
CDC Split Type: WAES96020134

Write-up: pt recvd vax;devel thrombocytopenic purpura;exp also an acute onset of escherichia coli 0157:H7 infection complicated by pseudomembranous colitis;died 7 days following vax;


VAERS ID: 84303 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted: 1996-03-29
Entered: 1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia
SMQs:, Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC Split Type:

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


VAERS ID: 85217 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Arkansas  
Vaccinated:1996-02-29
Onset:1996-03-08
   Days after vaccination:8
Submitted: 1996-03-25
   Days after onset:17
Entered: 1996-04-24
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Bronchitis
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-03-08
   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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


VAERS ID: 85412 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Foreign  
Vaccinated:1996-03-26
Onset:1996-03-29
   Days after vaccination:3
Submitted: 1996-04-26
   Days after onset:27
Entered: 1996-04-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asphyxia, Blood thromboplastin decreased, Lung disorder, Respiratory disorder, Unevaluable event
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Hostility/aggression (broad), 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: Phenobarbital
Current Illness:
Preexisting Conditions: convulsion;strabismus;
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES96041707

Write-up: pt recv vax 26MAR96 & pt was found dead in a prone position in bed;the COD was unk;no further details were provided;


VAERS ID: 86283 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1996-05-20
Entered: 1996-05-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0178A / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

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: No relevant data;
CDC Split Type: WAES96050726

Write-up: pt recv vax & shortly afterward pt exp a rapidly deteriorating condition & was hosp;pt died;COD was not reported;


VAERS ID: 89957 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Arizona  
Vaccinated:1996-09-09
Onset:1996-09-09
   Days after vaccination:0
Submitted: 1996-09-11
   Days after onset:2
Entered: 1996-09-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-09
   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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt dead-autopsy inconclusive @ this time;


VAERS ID: 90259 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1996-09-24
Entered: 1996-09-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injury
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


VAERS ID: 92248 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: New Jersey  
Vaccinated:1996-11-07
Onset:1996-11-08
   Days after vaccination:1
Submitted: 1996-11-18
   Days after onset:10
Entered: 1996-11-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0469D / 1 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Salivary hypersecretion
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-08
   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: sickle cell trait
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found foaming @ the mouth;died suddenly-autopsy results not available;


VAERS ID: 92503 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1996-11-05
Onset:1996-11-13
   Days after vaccination:8
Submitted: 1996-11-27
   Days after onset:14
Entered: 1996-12-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Coronary artery disease
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-13
   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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


VAERS ID: 93590 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:1995-02-23
Onset:1995-03-03
   Days after vaccination:8
Submitted: 1997-01-03
   Days after onset:672
Entered: 1997-01-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTIPV: DT + IPV (FOREIGN) / PASTEUR MERIEUX INST. - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hepatitis, Hepatocellular damage, Pyrexia
SMQs:, Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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: 1996-09-04
   Days after onset: 550
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: WAES96121641

Write-up: 03mar95 pt became febrile & was tx by MD w/ amoxicillin. 19apr95 a 2nd course of amoxicillin was initiated. 23apr96 pt devel hepatitis & was hosp for observation.pt devel liver dysfunction & was transferred to another hosp; pt died


VAERS ID: 94040 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alabama  
Vaccinated:1996-12-27
Onset:1996-12-29
   Days after vaccination:2
Submitted: 1997-01-07
   Days after onset:9
Entered: 1997-01-27
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-29
   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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


VAERS ID: 94918 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Foreign  
Vaccinated:1996-07-10
Onset:1996-07-19
   Days after vaccination:9
Submitted: 1997-02-10
   Days after onset:206
Entered: 1997-02-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injury
SMQs:, Accidents and injuries (narrow), Hostility/aggression (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:
Other Medications: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC Split Type: WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


VAERS ID: 95865 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1991-08-30
Onset:1992-12-15
   Days after vaccination:473
Submitted: 1997-03-12
   Days after onset:1548
Entered: 1997-03-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1150T / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-30
   Days after onset: 895
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: pt mom & w siblings tested positive for Von Willebrand''s disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES97030028

Write-up: pt recv vax & devel ITP & was hosp;MAY95 pt devel ITP for a 2nd time & died;


VAERS ID: 96398 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Tennessee  
Vaccinated:1997-02-18
Onset:1997-02-26
   Days after vaccination:8
Submitted: 1997-02-27
   Days after onset:1
Entered: 1997-03-21
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434814 / 4 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0393D / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-02-26
   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: unk
Preexisting Conditions: premie-7wk early followed @ hosp
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN97018

Write-up: death-asthma attack in MD office 26FEB97 & expired;had gone to hosp 25FEB97 to MD;


VAERS ID: 96570 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Arizona  
Vaccinated:1997-02-26
Onset:1997-02-28
   Days after vaccination:2
Submitted: 1997-03-19
   Days after onset:19
Entered: 1997-03-31
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 440644 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Somnolence, Urinary incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-03
   Days after onset: 3
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: fever, cough 2 days afeb 26FEB97
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: pt began vomiting on 28FEB97 t/c to MD on call 2MAR97 711PM describes vomiting no diarrhea no blood in vomit;urinating, sleeping but easily arousable;advice given w/instructions to call back if sx inc & in AM for appointment;


VAERS ID: 96864 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Arizona  
Vaccinated:1997-03-21
Onset:1997-03-28
   Days after vaccination:7
Submitted: 1997-03-31
   Days after onset:3
Entered: 1997-04-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Infection, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC Split Type: AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


VAERS ID: 97015 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New Hampshire  
Vaccinated:1996-12-30
Onset:1997-01-10
   Days after vaccination:11
Submitted: 1997-01-14
   Days after onset:4
Entered: 1997-04-21
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neonatal disorders (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


VAERS ID: 99047 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1997-06-02
Onset:1997-06-09
   Days after vaccination:7
Submitted: 1997-06-10
   Days after onset:1
Entered: 1997-06-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-06-09
   Days after onset: 0
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


VAERS ID: 101298 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-09-13
Onset:1995-09-21
   Days after vaccination:8
Submitted: 1997-08-01
   Days after onset:680
Entered: 1997-08-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Haemorrhage, Hepatic failure, Infection, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Noninfectious encephalitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-06-01
   Days after onset: 619
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC Split Type: WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


VAERS ID: 101589 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Foreign  
Vaccinated:1996-05-02
Onset:1996-05-11
   Days after vaccination:9
Submitted: 1997-08-06
   Days after onset:452
Entered: 1997-08-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
PER: PERTUSSIS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1996-05-11
   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: NONE
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: autopsy fulfills all criteria for SIDS;
CDC Split Type: WAES97072078

Write-up: pt recv vax 2MAY96 & exp no immed rxn p/vax; 11MAY96 pt died;autopsy protocol states that apart from being too old pt fulfils all criteria for sudden infant death synd (SIDS);reporter felt that COD was not f/t therapy w/MMR;


VAERS ID: 105905 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1997-12-26
Entered: 1997-12-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Infection
SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: biopsy brain measles inclusion bodies;
CDC Split Type: WAES97127928

Write-up: pt recv vax 1997 & pt exp encephalitis & was hosp;COD encephalitis, viral & measles inclusions bodies were found @ the brain biopsy;investigation found type 1 virus;


VAERS ID: 106256 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Texas  
Vaccinated:1997-12-10
Onset:1997-12-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (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? Yes
   Date died: 1997-12-19
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC Split Type: TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


VAERS ID: 107005 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1998-01-13
Onset:1998-01-13
   Days after vaccination:0
Submitted: 1998-01-20
   Days after onset:7
Entered: 1998-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81441 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1238D / 2 RA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 441228 / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-13
   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: Risperdal;wellbutin
Current Illness: OM
Preexisting Conditions: NKDA;obesity, depression
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt reportedly collapsed @ home suddenly


VAERS ID: 107036 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:1998-01-15
Onset:1998-01-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1998-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / UNK LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 1563E / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1801E / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, CSF test abnormal, Convulsion, Coordination abnormal, Delirium, Hypokinesia, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-01-23
   Days after onset: 3
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: NONE
Current Illness: URI
Preexisting Conditions: mild atopic dermatitis noted on 15JAN98
Allergies:
Diagnostic Lab Data: CSF showed 37WBC, 0RBC, repeat CSF p/sz WBC 140, RBC 90;
CDC Split Type: GA98003

Write-up: pt presented to ER w/refusal to walk, ataxia, devel sz;required intubation during hosp;CT scan cerebral edema, herniation, death;


VAERS ID: 112819 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Michigan  
Vaccinated:1998-07-06
Onset:1998-07-13
   Days after vaccination:7
Submitted: 1998-07-20
   Days after onset:7
Entered: 1998-07-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


VAERS ID: 114283 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1998-09-17
Entered: 1998-09-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Infection, Laboratory test abnormal, Lung disorder, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: human immunodeficiency virus infection
Allergies:
Diagnostic Lab Data: CXR parenchymal nodules;diagnostic microbiology cytopathic changes characteristic of measles infect;physical exam basilar pulmonary rales;pulmonary biopsy numerous multinucleated giant cells;
CDC Split Type: WAES98090695

Write-up: vaccine associated measles pneumonitis in adult w/AIDS;approx 1yr p/vax pt w/cough, dyspnea & fever;exam revealed pulmonary rales & chest x-ray showed parenchymal nodules;analysis of lung biopsy showed multinucleated giant cells;


VAERS ID: 114488 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Foreign  
Vaccinated:1998-09-09
Onset:1998-09-09
   Days after vaccination:0
Submitted: 1998-09-24
   Days after onset:15
Entered: 1998-09-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1000E / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acidosis, Agitation, Hypoxia, Pyrexia, Stupor, Sudden infant death syndrome, Syncope, Tachycardia, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-09-12
   Days after onset: 3
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: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: autopsy-hypoxic encephalopathy following out of hosp cardiac arrest;
CDC Split Type: WAES98091172

Write-up: pt recv vax 9SEP98 & 6hr post vax pt parents found pt collapsed & unresponsive;pt adm to ICU & was ventilated for 3 days;12SEP98 pt died;pt COD sudden infant synd;


VAERS ID: 116344 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1998-11-02
Onset:1998-11-07
   Days after vaccination:5
Submitted: 1998-11-09
   Days after onset:2
Entered: 1998-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0936780 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1370E / 3 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0935770 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0514H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 455656 / 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: 1998-11-07
   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: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: MS98026

Write-up: 7NOV98 respiratory arrest taken to hosp;no prior problems noted-child was nl & appeared healthy day of vax;no prev events noted;


VAERS ID: 116569 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Foreign  
Vaccinated:1998-11-09
Onset:1998-11-09
   Days after vaccination:0
Submitted: 1998-11-17
   Days after onset:8
Entered: 1998-11-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 111011A / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardiac failure, Cardiovascular disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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 (narrow), Cardiomyopathy (broad), Respiratory failure (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: unk
Current Illness:
Preexisting Conditions: aortic valve stenosis
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WAES98110919

Write-up: pt recv vax 9NOV98 & 3hr post vax pt exp sudden death;DOC unk;


VAERS ID: 116613 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Ohio  
Vaccinated:1998-09-17
Onset:1998-09-23
   Days after vaccination:6
Submitted: 1998-11-06
   Days after onset:44
Entered: 1998-11-23
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Cardiac arrest, Cardiovascular disorder, Infection, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-23
   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: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC Split Type: OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


VAERS ID: 116616 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Vermont  
Vaccinated:1998-10-07
Onset:1998-10-16
   Days after vaccination:9
Submitted: 1998-11-16
   Days after onset:31
Entered: 1998-11-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785H / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0644H / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hydronephrosis, Hypoxia, Pericardial effusion, Pulmonary oedema, Renal impairment, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: adopted child-birth parents siblings;hydronephrosis & renal insuff on autopsy
Allergies:
Diagnostic Lab Data: autopsy unrevealing of COD
CDC Split Type:

Write-up: unexplained infant death;autopsy finding of hydronephrosis & renal insufficiency not felt to be r/t pt death;


VAERS ID: 116883 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: California  
Vaccinated:1998-04-24
Onset:1998-04-28
   Days after vaccination:4
Submitted: 1998-11-02
   Days after onset:188
Entered: 1998-11-27
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0927950 / 1 - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0927950 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0026H / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Bradycardia, Cyanosis, Dehydration, Diarrhoea, Lung disorder, Pulmonary oedema, Shock, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-30
   Days after onset: 2
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: autopsy revealed dehydration w/moderate WBC''s in CSF;
CDC Split Type:

Write-up: child devel gastroenteritis 4 days p/vax; probably unrelated-devel worsening emesis & diarrhea over 2 days;despite intervention, pt subsequently went into shock & was taken to ER blue & pulseless;


VAERS ID: 118639 (history)  
Form: Version 1.0  
Age: 1.19  
Sex: Male  
Location: California  
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted: 1999-02-01
Entered: 1999-02-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


VAERS ID: 119190 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-02-18
Entered: 1999-02-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Delirium, Encephalitis, Immunoglobulins decreased, Laboratory test abnormal, Neuropathy, Oral candidiasis, Rash, Sepsis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: mild thrush & manila diaper rash;
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: brain biopsy-sparse lymphocytic meningoencephalitis, neuronal/oligodendroglial loss;reactive astrocytosis;diagnostic lab test profound depression of CD8 lymphocytes;IgG antibody low;lab test high complement fixing antibody titer ($g1:1024)
CDC Split Type: WAES99020300

Write-up: lit ref-pt recv vax & approx 8.5mo p/vax pt dx w/measles inclusion body encephalitis (MIBE);brain biopsy revealed sparse lymphocytic meningoencephalitis, moderate neuronal & oligodendroglia loss & reactive astrocytosis w/in cortex;


VAERS ID: 120450 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Alabama  
Vaccinated:1999-03-10
Onset:1999-03-13
   Days after vaccination:3
Submitted: 1999-03-18
   Days after onset:5
Entered: 1999-03-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 865A2 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0734E / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 79413 / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 10524 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Hepatomegaly, Laboratory test abnormal, Lymphadenopathy, Myocarditis, Neoplasm, Pneumonia, Pyrexia, Splenomegaly, Vaginal haemorrhage, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), 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), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-03-13
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: lt lung culture:Viridans Streptococcus, 2 colonies Candida, Haemophilus, beta lactamase+; rt lung culture: haemophilus, beta lactamase+; Blood culture: Staphylococcus epidermidis
CDC Split Type: AL9904

Write-up: hx of pt arriving in ER in full arrest & expired @ hosp;sl bloody vaginal discharge noted in ER;


VAERS ID: 121425 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Georgia  
Vaccinated:1999-03-11
Onset:1999-04-02
   Days after vaccination:22
Submitted: 1999-04-09
   Days after onset:6
Entered: 1999-04-23
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-03
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA99033

Write-up: None reported to this facility;


VAERS ID: 122669 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Unknown  
Vaccinated:1999-04-26
Onset:1999-04-28
   Days after vaccination:2
Submitted: 1999-05-20
   Days after onset:22
Entered: 1999-05-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Apnoea, Cardiac arrest, Ecchymosis, Pyrexia, Rash, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), 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), Neonatal disorders (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-05-02
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: lt hip dysplasia;otic infection;seizure
Allergies:
Diagnostic Lab Data: bacterial cult (blood/spleen/brain/lungs)=neg;xrays=nl; child had small bruise on head from fall-no evidence of trauma; viral cult (brain/lung/intestine) not avail
CDC Split Type: WAES99050142

Write-up: mo put sunscreen on face day of vax;2 days p/ vax little red dots on upper cheeks, not itchy & T99.3-99.5(ear);4th and 5th day p/ vax, afebrile but out of sorts & wanting to be held more; AM-6th day found dead in bed, COD SIDS, autopsy neg.


VAERS ID: 123185 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: New York  
Vaccinated:1995-02-10
Onset:1995-02-20
   Days after vaccination:10
Submitted: 1999-05-26
   Days after onset:1555
Entered: 1999-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Aplastic anaemia, Encephalitis, Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (narrow), Hypersensitivity (narrow), Myelodysplastic syndrome (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: roseola type virus,fever,rash p/ MMR #1~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: fever;viral exanthema;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99051409

Write-up: pt recv vax & became ill 10 days p/vax;pt had a viral synd which devel into encephalitis & was hosp;pt then devel aplastic anemia & dx w/Dubowitz synd;pt had recurrence of aplastic anemia;pt died


VAERS ID: 123218 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Oregon  
Vaccinated:1999-04-10
Onset:1999-04-30
   Days after vaccination:20
Submitted: 1999-05-21
   Days after onset:21
Entered: 1999-06-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC Split Type:

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


VAERS ID: 124936 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:1999-05-24
Onset:1999-06-01
   Days after vaccination:8
Submitted: 1999-06-15
   Days after onset:14
Entered: 1999-06-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Coagulopathy, Febrile convulsion, Gastroenteritis, Gastrointestinal haemorrhage, Grand mal convulsion, Lung disorder, Pulmonary oedema, Vaginal haemorrhage, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-06-01
   Days after onset: 0
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: twin recv OPV same day & devel diarrhea (see #125065)~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 6/1/99 blood culture neg, CSF neg, metabolic screen for toxic substance neg, mean platelet vol 6.9 low,
CDC Split Type: WAES99060681

Write-up: pt recv vax 5/24/99 & 6/1/99 pt was found to have a fever & p/waking up from nap, had sz & was rushed to ER where was unable to be resuscitated;COD @ time of reporting was unk;


VAERS ID: 126855 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-07-29
Entered: 1999-08-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Pyrexia
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), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99071550

Write-up: rpt from anonymous person concerning pt who was vax & exp slight fever, tx w/tylenol; pt found dead next morning; COD unk; the rpt stated info was recv as "hearsay'''' through small town grapevine & cannot be verified.


VAERS ID: 127043 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1998-10-07
Onset:1998-12-21
   Days after vaccination:75
Submitted: 1999-08-02
   Days after onset:223
Entered: 1999-08-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-21
   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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death; autopsy performed by county; aspiration pneumonia;


VAERS ID: 129134 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Virginia  
Vaccinated:1999-09-09
Onset:1999-09-29
   Days after vaccination:20
Submitted: 1999-10-04
   Days after onset:5
Entered: 1999-10-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-29
   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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC Split Type:

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


VAERS ID: 129511 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1999-07-08
Onset:1999-09-14
   Days after vaccination:68
Submitted: 1999-10-14
   Days after onset:30
Entered: 1999-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-14
   Days after onset: 0
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


VAERS ID: 131353 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Foreign  
Vaccinated:1999-10-21
Onset:1999-10-24
   Days after vaccination:3
Submitted: 1999-11-19
   Days after onset:26
Entered: 1999-11-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, CSF test abnormal, Cardiac arrest, Coma, Confusional state, Convulsion, Electroencephalogram abnormal, Encephalitis, Headache, Infection, Laboratory test abnormal, Meningitis, Nausea, Nuchal rigidity, Paraesthesia, Pyrexia, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-11-04
   Days after onset: 11
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: UNK
Allergies:
Diagnostic Lab Data: 10/28/99 electroencephalography-severe cerebral distrubances;MRI intraparenchymatous lesions evoked dx of herpetic infect process;herpes;lyme negative;mycoplasm IG=12;10/30/99 electroenephalography-confirmed aggravation of cerebral lesions;
CDC Split Type: WAES99111051

Write-up: p/vax pt w/drowsiness & cephalagia;hosp & fever & tonic clonic convuls;no motor deficiency but paresthesia & meningism (nausea & neck stiffness);pt confused;to ICU exp cardiac & resp arrest;state IV coma;dx meningoencephalitis;pt died


VAERS ID: 131605 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Foreign  
Vaccinated:1999-10-21
Onset:1999-10-24
   Days after vaccination:3
Submitted: 1999-11-22
   Days after onset:29
Entered: 1999-12-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Encephalitis, Infection
SMQs:, Noninfectious encephalitis (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WAES99111359

Write-up: p/vax pt exp meningoencephalitis;11/4/99 pt died;COD was infectious meningoencephalitis;


VAERS ID: 133895 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2000-01-25
Onset:2000-02-01
   Days after vaccination:7
Submitted: 2000-02-04
   Days after onset:3
Entered: 2000-02-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Encephalopathy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


VAERS ID: 134580 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Foreign  
Vaccinated:1999-12-08
Onset:1999-12-17
   Days after vaccination:9
Submitted: 2000-03-01
   Days after onset:75
Entered: 2000-03-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC
MNC: MENINGOCOCCAL (MENINGITEC) / PFIZER/WYETH - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: CSF test abnormal, Convulsion, Hernia, Pneumonia
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cerebrospinal fluid-protein rasied (1.2g/l)
CDC Split Type: 20000052892

Write-up: 9 days post vax, pt exp convulsions. Overnight neurological status worsened, pt died early 11/18. Cause of death: convulsion NOS. Post-mortem: bronchopneumonia, tonsillar herniation. Final brain post-mortem awaited. No further info avail.


VAERS ID: 150243 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-03-07
Onset:2000-03-11
   Days after vaccination:4
Submitted: 2000-03-13
   Days after onset:2
Entered: 2000-03-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388BA / 4 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG314009 / 4 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0548AA / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0473 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0928J / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Atelectasis, Brain oedema, Convulsion, Foetal disorder, Hyperplasia, Liver disorder, Petechiae, Pulmonary congestion, Pulmonary oedema, Renal disorder, Spleen disorder, Tremor
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Foetal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy to be performed
CDC Split Type: MS00007

Write-up: No reaction or illness was noted after vaccine until the morning of 3/11/00. The child was playing and then laid down on couch and started shaking and stopped breathing. Autopsy showed cause of death to be consistent with seizure. Other findings of pulmonary vascular congestion and edema, atelectasis of the lungs, hepatic congestion, petechiae of the thymus, splenic congestion, reactive lymphoid hyperplasia of the mesenteric lymph nodes, renal congestion, fetal lobulation of the kidneys, cerebal edema.


VAERS ID: 150733 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-07-01
Onset:1995-06-07
   Days after vaccination:341
Submitted: 2000-03-30
   Days after onset:1758
Entered: 2000-04-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Apathy, CSF test abnormal, Coma, Confusional state, Crying, Dysarthria, Dystonia, Electroencephalogram abnormal, Encephalitis, Hyperreflexia, Myoclonus, Speech disorder, Tachycardia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: EEG-periodic high-voltage generalized sharp waves, CSF measles IgG titer-160 units, CSF measles IgG index-3.7, HIV-neg
CDC Split Type: WAES00032144

Write-up: Post vax, the pt presented with progressive confusion, crying spells, and social withdrawal. Three months after symptom onset, he developed intermittent dystonic posturing of the left arm and leg. Initial neurological exam was significant for dysarthria and myoclonus of the left arm and leg. During the fourth month of illness, the pt developed hyperreflexia, and extensor plantar responses. By the fifth month, the myoclonus ceased. He became unresponsive, mute, and displayed intermittent hyperreflexia and tachycardia suggesting autonomic dysfunction. He expired six months after the onset of symptoms. An autopsy was refused. The cause of death was subacute sclerosing panencephalitis. Information about this case is described in an unpublished manuscript entitled "Subacute sclerosing panencephalitis in US born adult".


VAERS ID: 150875 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Indiana  
Vaccinated:1999-08-27
Onset:1999-09-01
   Days after vaccination:5
Submitted: 2000-03-06
   Days after onset:187
Entered: 2000-04-10
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-09-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC Split Type:

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


VAERS ID: 151082 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2000-03-27
Onset:2000-03-29
   Days after vaccination:2
Submitted: 2000-04-25
   Days after onset:26
Entered: 2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Accident, Anaemia, Brain oedema, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-04-25
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC Split Type:

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


VAERS ID: 152566 (history)  
Form: Version 1.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2000-03-30
Onset:2000-04-12
   Days after vaccination:13
Submitted: 2000-05-24
   Days after onset:42
Entered: 2000-06-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Malignant lymphomas (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-05-25
   Days after onset: 43
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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


VAERS ID: 152670 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-05-15
Onset:2000-05-25
   Days after vaccination:10
Submitted: 2000-05-30
   Days after onset:5
Entered: 2000-06-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1275J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Brain oedema, Liver disorder, Pallor, Pharyngitis, Pneumonia, Pulmonary congestion, Pyrexia, Rash macular, Respiratory failure, Rhinitis
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD - Lot number 0090P, ID, RA
Current Illness: NONE
Preexisting Conditions: febrile seizures, pneumococcal bacteremia
Allergies:
Diagnostic Lab Data: CBC-5500
CDC Split Type:

Write-up: on 5/25/00, pt had fever, cold symptoms for 2 days, runny nose, red pharynx, a few papules on face, WBC 5,500. 5/27 via phone call, pt was pale, had macular rash on nose and face, fever was 100.8. Pt was taken to ER on 5/28. DOA, (probably several hours). Autopsy states liver congestion, lung atelectasis, lung congestion, respiratory failure due to streptococcal (group B) pneumonia, ceberal edema,


VAERS ID: 154205 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-06-08
Entered: 2000-06-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Lymphocytosis, Pneumonitis
SMQs:, Interstitial lung disease (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: WAES00060390

Write-up: Information has been received concerning a pt who at approximately 13 months old was vaccinated with MMR. Subsequently at 18 months old the pt died with a diagnosis of erythrophagocytic lymphohistiocytosis. Autopsy revealed a "giant cell pneumonitis". It was also noted that "measles RNA (presumably) was detected in lung tissue". Additional information has been requested.


VAERS ID: 155775 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: New Mexico  
Vaccinated:2000-06-09
Onset:2000-06-17
   Days after vaccination:8
Submitted: 2000-06-20
   Days after onset:3
Entered: 2000-06-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC Split Type:

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


VAERS ID: 158472 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Foreign  
Vaccinated:2000-07-04
Onset:2000-07-05
   Days after vaccination:1
Submitted: 2000-08-01
   Days after onset:27
Entered: 2000-08-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER R10783 / 2 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 121011A / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bacterial infection, Malaise, Sepsis
SMQs:, Agranulocytosis (broad)

Life Threatening? Yes
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obesity, metabolic disorder
Allergies:
Diagnostic Lab Data: Autopsy revealed cause of death as pneumococcal sepsis.
CDC Split Type: WAES00072420

Write-up: This 11-year-old male received vaxs and one day post vax, became "severely ill (not specified) and was admitted to the hospital. Reanimation was unsuccessful and the pt died. An autopsy was performed that revealed a pneumococcal sepsis," which was the cause of death. Severe malaise was also considered life threatening event.


VAERS ID: 159871 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Foreign  
Vaccinated:2000-03-27
Onset:2000-04-27
   Days after vaccination:31
Submitted: 2000-09-13
   Days after onset:139
Entered: 2000-09-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

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? Yes
   Date died: 2000-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES00082984

Write-up: On 4/27/00, the pt collapsed and died from an unknown cause. No post-mortem was performed. The pt took no other drug within the past three months. The reaction text stated "Probably first fit but no clear evidence. Question was raised as the whether MMR is relevant to seizure. No further information is available.


VAERS ID: 163135 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Tennessee  
Vaccinated:2000-09-05
Onset:2000-09-06
   Days after vaccination:1
Submitted: 2000-11-05
   Days after onset:60
Entered: 2000-12-06
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Unevaluable event
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


VAERS ID: 164713 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Massachusetts  
Vaccinated:2001-01-05
Onset:2001-01-06
   Days after vaccination:1
Submitted: 2001-01-08
   Days after onset:2
Entered: 2001-01-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0313AA / UNK RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471876 / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1327J / UNK LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473341 / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1869J / UNK LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-01-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Poliovax by Connaught, Lot #R0692 given SC
Current Illness: Constipation
Preexisting Conditions: Cerebral dysgenesis, congenital CMV, developmental delay
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 1/8/01, the physician received a phone call stating that the pt died on 1/6/01 in the A.M.


VAERS ID: 164955 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:1990-02-01
Submitted: 2001-01-15
   Days after onset:4001
Entered: 2001-01-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coma, Convulsion, Drug ineffective, Dysarthria, Electroencephalogram abnormal, Encephalitis, HIV infection, Haemoglobin decreased, Leukopenia, Lymphopenia, Muscle twitching, Necrosis, Nervous system disorder, Respiratory distress, Tachypnoea, Thrombocytopenia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lack of efficacy/effect (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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:
Other Medications: hemophilia A, HIV
Current Illness:
Preexisting Conditions: Hemophilia A; human immunodeficiency virus infection
Allergies:
Diagnostic Lab Data: CSF and CT of head-were nml; EEG-showed right frontal slowing with spike discharges centrally; CBC-nml; CXR-nml; lab-showed evidence of the syndrome of inappropriate secretion of adrenocorticotropic hormone was found; Titers of measles antibody at this time were undetectable; autopsy-the brain weighed 1.540 g (expected weight, 1.350 g) and its gross characteristics were nml; Focal acute neuronal necrosis was evident in the dentate nucleus
CDC Split Type: WAES01010267

Write-up: In 4/90, 11 days post vax, the pt experienced recurrent focal seizures. At the time his HIV infection was diagnosed in 10/85, blood analysis consistently revealed leukopenia, mild thrombocytopenia and hemoglobin concentrations of 11.2 to 13.6, lymphocyte counts were around 200-300, CD4 to CD8 ratios of 0.2-0.47. In 10/89, therapy with zidovudine was initiated. The pt had no symptoms related to HIV infection or zidovudine therapy. Although he had received the measles vaccine in 1973 at the age of 3 and a dose of MMR in 1976 at the age of 7, the pt was admitted to the hospital for three days in 2/90 with uncomplicated measles. Tachypnea and respiratory distress responded promptly to therapy with oxygen and aerosolized ribavirin. The pt responded well until two months later, when he presented after two days of recurrent right arm twitches without fever. Physical exam revealed only continuous fine twitches of th right arm. CSF analysis and computed tomography of the head gave normal results, electroencephalography, however, showed right frontal slowing with spike discharges centrally, persisted despite therapeutic anticonvulsant concentrations in serum. the pt was admitted 11 days after the onset of seizures for further diagnostic evaluation. At the time of admission, he was conscious and afebrile. He had right-arm and right-leg twitching but was able to walk. His mental status and the results of motor and sensory examination were normal. Although the latter condition responded to the fluid restriction, the pt developed slurred speech and gradually became unresponsive requiring endotracheal intubation. A 10 day course of IV therapy was given. The pt remained comatose, experiencing continuous focal seizures that could not be controlled with anticonvulsant agents. Neurological and electroencepahlographic exam on day 24 of hospitalization indicated brain death. Mechanical ventilation was discontinued on day 30. The cause of death was subacute measles encephalitis.


VAERS ID: 165792 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2001-02-06
Entered: 2001-02-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Aspiration, Dizziness, Gastritis, Hypotonia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: sibling hx of flaccid attacks unrelated to vaccinations.
Allergies:
Diagnostic Lab Data: autopsy - aspiration of vomit caused by acute gastritis
CDC Split Type: WAES01012076

Write-up: 8 days post vax the parents noted flaccidity and faintness a few hours preceding the death, but the symptoms subsided immediately and the pt seemed entirely healthy when put to bed. Forensic autopsy disclosed the cause of death as aspiration of vomit caused by acute gastritis. No further information is available. No date of death available.


VAERS ID: 165922 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Florida  
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted: 2001-02-13
Entered: 2001-02-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-12-13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


VAERS ID: 165974 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Florida  
Vaccinated:2001-01-16
Onset:2001-01-23
   Days after vaccination:7
Submitted: 2001-02-14
   Days after onset:22
Entered: 2001-02-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), 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? Yes
   Date died: 0000-00-00
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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC Split Type: WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


VAERS ID: 167085 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Foreign  
Vaccinated:2001-02-21
Onset:2001-02-23
   Days after vaccination:2
Submitted: 2001-03-08
   Days after onset:13
Entered: 2001-03-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0615J / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Bacterial infection, Blood pressure decreased, Brain oedema, Disseminated intravascular coagulation, Hepatomegaly, Hypotension, Hypoxia, Leukocytosis, Liver function test abnormal, Pyrexia, Sepsis
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-02-25
   Days after onset: 2
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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: BP-50/30; temp-35C; pertinent blood results from this hospital were: WBC-33,000,000/liter (leukocytosis); lymphocytes-56%; neutrophils 34%; monocytes 9%; basophils 1%; "deranged" liver function tests; Nml ammonia and blood cultures showed coagulase neg staphylococci indentified as being skin contaminants; post mortem was being conducted on 2/25/01.
CDC Split Type: WAES01030189

Write-up: Information was received from a health professional concerning an 18 month old male who on 02/21/01, in the afternoon, was vaccinated with the MMRII. On 02/23/01, at 3 AM he was found in his bed "having a fit" with a temp of 40 degrees C. He was admitted to the hospital where he deteriorated rapidly. At 7:20 AM he was transferred to the pediatric ICU at another hospital. During his transfer, the child deteriorated and was described as "flat" and essentially brain dead on arrival. The anaesthetist suspected the patient may have "coned" (coning: axial displacement of the cerebellar tonsils through the foramen magnum) at that point. He was resuscitated by treatment with inotropes, antibiotics and ventilation. He had overwhelming sepsis with DIC. He was ventilated from 02/24/01 in the AM. On 02/25/01 the ventilator was switched off and the patient died. The cause of death was bacterial sepsis and disseminated intravascular coagulopathy. A post mortem was being conducted on 02/26/01. This information was received by Aventis Pasteur MSD manufacturer # UK011318. On F/U, the post mortem conducted on 2/26/01 revealed large swollen liver, clear meninges and a swollen brain. The cause of death was established as sepsis and a microscopic exam of the lung showed a 2 day old bronchopneumonic condition. No organism has yet been identified. It was reported that the family history is significant for a similar episode in sibling (did not report if related to a certain vaccination). The mother had 5 pregnancies, of which only 2 children remain. One was a stillbirth at term. One was a 4.5 year old child who died during a "fit" of a very rare degenerative brain condition (Otoharan syndrome). This is an amended report. The batch number HK45610 has been added to the narrative.


VAERS ID: 167376 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Virginia  
Vaccinated:2001-02-20
Onset:2001-02-23
   Days after vaccination:3
Submitted: 2001-03-15
   Days after onset:20
Entered: 2001-03-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Contusion, Nasal congestion, Pulmonary oedema, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-02-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


VAERS ID: 169360 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2000-09-08
Onset:2000-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private       Purchased by: Private
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: 2000-09-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


VAERS ID: 170058 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New York  
Vaccinated:2001-04-13
Onset:2001-04-22
   Days after vaccination:9
Submitted: 2001-05-13
   Days after onset:21
Entered: 2001-05-22
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394K / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 4 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1155K / UNK - / SC

Administered by: Private       Purchased by: Other
Symptoms: Albumin globulin ratio abnormal, Blood calcium increased, Blood lactate dehydrogenase increased, Cardiac arrest, Dehydration, Erythema multiforme, Haemoglobinaemia, Meningitis, Pyrexia, Red blood cell sedimentation rate increased, Respiratory arrest, Sepsis, Shock, Skin necrosis, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Haemolytic disorders (narrow), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (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), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-04-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chinese herbs (unspecified)
Current Illness:
Preexisting Conditions: History of allergies and eczema; on 6/12/00, the pt had a hematoma on the forehead (CT Scan was nml)
Allergies:
Diagnostic Lab Data: Full blood work-up and blood cultures were negative; temperature 101F; CBC-nml except for a few extra bands. PCR and VZV analysis-neg; WBC-8.4 and 8.1; serum calcium-10.8 (high); albumin-4.4 (high); mean corpuscular hemoglobin concentration of 33.9 (high); LDH-541 (high); neutrophil ct-19%; hematology-14%; ESR-34; antistreptolysis O antigen test-5.0; skin biopsy-clusters of necrotic keratinocytes in the superficial epidermis and a small amt with also exocytosis of mononuclear cells and some extravascated erythrocytes and these features are difficult to interpret and is being tested for viran DNA
CDC Split Type: WAES01050031

Write-up: Information has been received from a physician concerning a 12 month old female who was vaccinated with MMRII and varicella virus vaccine live. Ten days later, the pt developed a fever and rash. The physician noted that under the microscope he can not determine what caused the rash. Follow-up from the physician indicated that he was the pathologist who had received the skin biopsy specimen of the rash from the pt''s dermatologist. He received the specimen, 3 days prior to the pt''s death. Additional information from the pt''s pediatrician, indicated that the child received MMRII, varicella and Prevnar on 4/13/01 and on 4/25/01, the pt was brought into the office with a fever of 101F associated vomiting, lethargy, dehydration and a generalized rash that looked like erythema multiforme. Another physician was working with the physician that day and they both agreed that it looked like erythema multiforme. The parents were told to bring the pt back on 4/26/01 for a follow-up visit. On 4/26/01, the rash still appeared as erythema multiforme, however, it was not as generalized and was more discrete. The parents reported that the child was also on a Chinese herbal medicine and the baby sitter reported that the child had eaten a new kind of fish that night. The pediatrician referred the pt to a dermatologist and when he saw the pt, he reported that he had never seen anything like the rash that the pt presented with and he did a skin biopsy. The next day, the pediatrician called the pt''s home to check her condition. The child''s baby sitter reported that the child was doing fine, eating, drinking and the rash was getting better. On 4/27/01, the pediatrician called the pt''s home again and wanted the child to come in to be seen, however, the family was reluctant because they reported the child was doing fine, the rash had faded and the child''s fever was gone. On the night of 4/28/01, the family took the child to the ER. The ER physician called the pt''s pediatrician and told her that the pt presented to the ER with fever, crying with no tears and dehydration and vomiting. The ER physicians were unable to get an IV line into the child, the child went into shock and arrested, with failure to revive. The family refused to autopsy. The cause of death on the death certificate was meningococcal meningitis. The pediatrician reported that the cause of death could not possibly be meningococcal meningitis because the blood cultures that she had done on the pt at the height of the rash on 4/25/01 were negative and the fever and rash had gone away without any prophylaxis treatment. The pt''s father could not tell the pediatrician the name of the Chinese medication, only that it was herbal Chinese medication. The pediatrician reported that a piece of the skin biopsy was sent for PCR analysis and the pediatrician was unsure if this would be conclusive or not. The pediatrician also reported that there was no blood obtained for IgG or IgM titers. The pediatrician noted that she did not know the cause of death. The child''s body was being taken to another country to be buried. Follow-up from another physician indicated that the pt had negative blood cultures taken in the PCP''s office and he was not sure where the dx of meningococcal meningitis came from without further lab support. He was questioned as to whether the community where the child lived may need prophylaxis and from the description of the child''s symptoms, he did not feel the symptoms were consistent with a meningococcal bacteria. The physician noted that the child looked septic on admission to the hospital and he wondered if the child was actually dehydrated. The physician was unsure if the child 1st respiratory or cardiac arrested, however, he did feel that it would be unusual for a child this age to 1st cardiac arrest. The physician confirmed that the child did eat a different type of fish and wondered if the child may have contracted a Vibrio infection from ingesting infected raw fish. Conflicting information from this physician indicated that the child was seen on 4/22/01 by the PCP and a maculopapular rash was dx''d as an atypical measles type rash. The child''s rash then reportedly improved however on admission to the ER, the child reportedly had a florrid, "violatious" rash. The physician wondered about the child''s immune status, since the child lived on a commune where group marriages occurred. The commune consisted of approx. 300-400 people. The physician noted that this was all just philosophical discussion since an autopsy was not performed and the cause of death will probably not be known. No further details were provided. Additional information received on 05/23/2001 indicated that PCR results from the parafin block extraction were negative for V2V. Additionally the specimen was concentrated down, in hopes of going further and making it more sensitive; however, it was still negative for V2V. The patient''s physician was planning to have a PCR done for measles, as "atypical measles" was one of the clinical diagnoses for the pt. The physician reaffirmed that she did not believe the child''s rash was varicella. The physician plans to have additional specimens sent for measles PCR. Additional info has been requested. Follow-up info has been received from a physician who stated that, according to the CDC, the skin tissue tested neg. for MMR. He also reported that the VZV was neg. Additional information has been requested.This is an amended report. The pt''s age was changed from 12 months to 13 months. This is a corrected report as amended.


VAERS ID: 174275 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Foreign  
Vaccinated:1999-10-08
Onset:1999-10-11
   Days after vaccination:3
Submitted: 2001-08-03
   Days after onset:662
Entered: 2001-08-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Anaemia, Anorexia, Aspartate aminotransferase increased, Cardio-respiratory arrest, Dehydration, Diarrhoea, Hyperaemia, Hyperbilirubinaemia, Hyperchromic anaemia, Hypochromic anaemia, Hypotension, Infection, Interstitial lung disease, Laboratory test abnormal, Prostration, Pruritus genital, Pyrexia, Respiratory distress, Tachypnoea, Vomiting, Vulval disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), 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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-16
   Days after onset: 5
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:
Other Medications:
Current Illness:
Preexisting Conditions: Aseptic meningitis; bronchitis; diarrhea; low birth weight
Allergies:
Diagnostic Lab Data: Biopsy-diffuse interstitial infiltrate; neurological exam of CSF-nml: WBC-12,000/L; hematocrit-34%; serum aspartate aminotransferase-114 IU/L; total serum bilirubin-18.8 umol/L; serum immunoglobulin M test-neg. WBC count 12000. Post-mortem bx-histopathological exam revealed changes consistent with those seen in wild-type yellow fever; serum protein electrophoresis was positive for yellow fever virus
CDC Split Type: WAES01077925

Write-up: Information has been received from a physician concerning a 5 year old white female who on 10/8/99 was vaccinated with MMRII and was given a simultaneous but separate vaccine of yellow fever virus vaccine live. Three days, post vax, the pt developed a fever (39.6C) and diarrhea, and the next day, anorexia, vomiting and vulva pruritus and was seen in the ER. On exam, the pt was tachypenic, had a hyperemic pharynx, was anemic (hematocrit 34%) and had raised serum aminotransferase concentrations (aspartate aminotransferase 114 IU/L, alanine aminotransferase 160 IU/L), bilirubin concentration was slightly raised (18.9 umol/L). On the 4th day, the pt had prostration, respiratory distress, increased vomiting and diarrhea, dehydration and scleral icterus. Abdominal exam revealed enlarged, tender liver. Possible meningismus was noted. Differential dx of pneumonia and meningitis was added. CSF exam was normal. CXR revealed diffuse interstitial infiltrate in the left lung. The hematocrit fell to 30%, total leucocyte count was 12,000/L. The next day, the pt was admitted to ICU and was hypotensive, not perfusing, cyanotic, in acute respiratory distress. The pt had a cardiorespiratory arrest, was resuscitated but died within the next hour. On 10/16/99, the pt died. The cause of death was yellow fever. A meeting of yellow fever experts was convened in May 2000 and the panel unanimously concluded that the vaccine virus was the probable cause of fatal infections, which closely resembled wild-type yellow fever. Additional information is not expected.


VAERS ID: 174843 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Colorado  
Vaccinated:2000-10-18
Onset:2000-10-26
   Days after vaccination:8
Submitted: 2001-08-28
   Days after onset:306
Entered: 2001-08-31
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


VAERS ID: 174865 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Texas  
Vaccinated:2001-08-08
Onset:2001-08-12
   Days after vaccination:4
Submitted: 2001-08-22
   Days after onset:10
Entered: 2001-09-04
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0739L / 2 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Brain oedema, Headache, Hernia, Lethargy, Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2001-08-18
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy results state histologic findings are most consistent with a viral etiology, however, antemortem serologic tests and postmorterm cultures fail to elucidate the etiology. Although ADEM was considered, stains failed to demonstrate a demyelinating process as is classically demonstrated in this lesion.
CDC Split Type:

Write-up: On 8/12/01, pt had a headache; on 8/14/01 pt had a headache and a fever; on 8/15/01, the pt was lethargic; on 08/17/01, pt had herniation and on 8/18/01; life support removed. Death certificate states cause of death to be cerebral edema due to viral illness.


VAERS ID: 178593 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2001-11-02
Onset:2001-11-19
   Days after vaccination:17
Submitted: 2002-03-11
   Days after onset:112
Entered: 2001-12-05
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0815L / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1091L / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-11-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Varicella
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01112752

Write-up: Information has been received from a physician concerning a 25 year old male with no known allergies or psychiatric history and a history of varicella who on 02-NOV-2001, at 11:00 AM, was vaccinated with a dose of MMR (second generation). Concomitant therapy included Recombivax HB. There was no other concomitant medication. It was noted that the pt was seen later that day in the early evening, at 6:00 PM, then disappeared. On 19-NOV-2001 the pt''s dead body was recovered in the river. It was reported that it was an assumed suicide. The physician reported that she only saw the client for immunizations. Unspecified medical attention was sought. Additional information has been requested. Follow-up info from the reporter indicated that "in her mind there is no connection between the vaccination and the death." Additional info has been requested.


VAERS ID: 178961 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Foreign  
Vaccinated:2001-10-15
Onset:2001-10-20
   Days after vaccination:5
Submitted: 2002-01-30
   Days after onset:102
Entered: 2001-12-13
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Abnormal behaviour, Cyanosis, Eye disorder, Hypoxia, Laboratory test abnormal, Neurological symptom, Pyrexia, Respiratory distress, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-10-27
   Days after onset: 7
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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Varicella
Allergies:
Diagnostic Lab Data: Radiology-revealed b/l fleecy pneumopathy; ophthalmologica exam-did not follow light (papilla with pale coloration); arterial blood gas measurement-hypoxamia reacting to oxygen w/0 hypercapnia; total heartbeat count-tachycardia; CSF glucose-glycorrachia; cerebrospinal fluid total protein test-proteinorrhachia; cerebrospinal fluid culture-sterile
CDC Split Type: WAES01113361

Write-up: Information has been received from a health professional concerning a 16 month old male who in 11/01 was vaccinated in the left arm with a 1st dose of MMRII. Five days, post vax, the child experienced a fever and breathing disorder. Then, within the following night, his respiratory disorder was aggravated and in the morning he presented with cyanosis, respiratory distress and neurological trouble (shifty eyes). He was hospitalized, received oxygen and was ventilated. A few days later, he died. The dx was acute respiratory distress syndrome probably of viral origin. The exact cause of death was not specified. It was noted that he had received previous immunizations without any problem. No autopsy was performed. No further information is available. Follow-up info from the hospital medical record indicated that the boy was the third child of a three children family in good general state of health and was born at 36.5 weeks of amenorrhea. He experienced varicella in July 2001. He received his MMR on 10/15/2001. The infant did not present with any pathology and had an excellent psychomotor development. The first symptoms appeared on 10/20/2001 with febrile syndrome and respiratory troubles associated with a laryngitis treated with homeopathy. On 10/21/2001, two episodes of post food vomiting occurred and the child was cyanotic and dyspneic when he woke up. The prarents described their child as absent and with an altered behavior. There was no notion of head injury or drug poisoning. He received prednisone and epinephrine and was transferred to an intensive care unit. Upon admission, hemodynamic was correct, saturometry (83%) at ambient temperature. He received oxygen by nasal route and saturation reached 92-93%, fever was at 40 deg. C, tachycardia at 180/min. There was also dyspnea., absence of ocular following intermittent strabismus, obnibulation and peripheral hypertonia. The ENT examination was normal. Thorax radiography revealed a bilateral fleecy pneumopathy. Arterial garometry showed hypoxemia reacting to oxygen without any hypercapnia. The first diagnosis was the following: infectious pneumopathy associated with an infectious or hypoxic encephalopathy. During hospitalization, pulmonary lesions aggravated with stubborn hypoxemia and signs of typical and severe acute respiratory distress syndrome which necessitated intubation, ventilation controlled with enalgesic sedation and curarisation. Pneumothorax right then left were drained by pleurocath. A diffuse, generalized ventilated received antibiotics and received dobutamine after placement of a central venous route and azots monoxide. The child was transferred to another intensive care unit on the fifth day of care for severe SDRA (azote monoxide dependent) and a therapy with oscillator and respiratory assistance were introduced. On 10/27/2001 the child died. In conclusion, the child experienced an acute respiratory distress syndrome, probably secondary to an infectious pulmonary pathology, from probable viral origin. It was not possible to distinguish a hypoxic encephalopathy secondary to the SDRA and a viral infectious encephalitis. Serum and CSF were still available. No further info is available.


VAERS ID: 179070 (history)  
Form: Version 1.0  
Age: 1.75  
Sex: Male  
Location: California  
Vaccinated:2000-12-01
Onset:2001-01-09
   Days after vaccination:39
Submitted: 2001-12-03
   Days after onset:328
Entered: 2001-12-17
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 973A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471871 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 92030 / 2 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1161K / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Aggression, Anorexia, Apnoea, Blister, Brain stem syndrome, Cyanosis, Epistaxis, Fatigue, Irritability, Lacrimation increased, Pyrexia, Splenomegaly, White blood cell count increased
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: 2001-01-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Children''s Motrin prior to vaccinations
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: On 12/1/00, my son was given 4 vaccinations. His appointment was at 09:15. The morning of 12/2/00, he was out of sorts. He had a low fever, he didn''t have an appetite, he was extremely tired and very cranky. He was not acting in the usual manner at all. I know that vaccinations can sometimes cause these types of symptoms. I gave him the recommended dosages of Children''s Motrin throughout the day to lower his fever. It alternated between 100F and 101F. On 12/3/00, he continued to be very cranky but his fever had gone away. He was acting unusually aggressive. He was not his "normal" self, but he did not show extreme signs of illness. My husband and I both commented that we hoped the vaccinations had not caused him some kind of harm. This child was normally extremely easy going and never cranky. In fact, it was the 1st time we had seen him in a "bad" mood. On 12/4/00, he woke up in the morning and as I was getting him dressed, I noticed that he had 1 fluid filled blister on the top of each of his knuckles. (I had been under the impression that he had received his Varicella vaccination per the nurse at my doctor''s office). I called the advice nurse and told her about his blisters. She said that they were probably a result of his vaccination. She indicated that they were contagious until they dried up. By 12/6/00, they were completely gone. They did not crust over or anything, they just disappeared. He actually did not receive his Varicella vaccination, so they could not have been chickenpox. Throughout the month of December, he continued to act really tired and would take long naps. I did not know why he was sleeping so much, but he did not exhibit classic symptoms of obvious illness. He also had some unusual behavior that he was crankier than usual. On 1/9/00, we were playing at about 16:00. He began rubbing his eyes. I asked him if he wanted to go "night night" and he responded "yes". I took him into my bedroom and we rested on my bed. He rubbed his eyes and said, "Owie". A few tears rolled out the sides of his eyes as if his eyes were tearing. He rolled over and fell asleep. By this time it was 16:20. His older brother and a friend were playing in the room where he was sleeping. I told them to play outside so they would not wake him. I checked on him several times. At 17:00, I looked in on him and found him face down. I turned him over and he was blue, his eyes were half open and he wasn''t breathing. He had blood coming out of his nose. I began CPR. My son called 911. He never regained consciousness. He was pronounced dead at the hospital about 1.5 hours after I found him. This was a perfectly healthy child. An autopsy was done. The cause of death was undetermined. Upon 6 months of further investigation, the Medical Examiner still has no absolute cause of death. The main findings are that his spleen was enlarged and full of white pulp (denoting massive white blood cell production) and his brainstem had a foci of mild inflammation. It has always been my gut feeling that he was harmed by his vaccinations. I have never been opposed to vaccinations. My other child and this child ha both been regularly immunized. I know investigators don''t believe in intuition, but I have a very uneasy feeling about this round of immunizations. I can''t say why, it is just a feeling that I now trust. I hope you give the death of my child a thorough investigation. I would hate for another child to die or a family to have to go through this gut wrenching hell and grief. The truth is, children are rarely harmed by immunizations. I want to know if my son was that one in a million. It is very hard not to know why your perfect, healthy child suddenly dies in an instant with no explanation. I appreciate your attention and diligence in honoring the need for an extensive investigation.


VAERS ID: 179416 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Unknown  
Vaccinated:1998-01-01
Onset:0000-00-00
Submitted: 2001-12-20
Entered: 2001-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Encephalitis, Neurodevelopmental disorder
SMQs:, Noninfectious encephalitis (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0112USA01104

Write-up: Information has been received from a physician for a case in litigation concerning a 7 year old male who in approximately 1998 was vaccinated with MMR II, also referred to as the "triple measles vaccine" by the physician. The pt presented with a history of recent psychomotor retardation without any associated history or signs of an infectious or neoplastic process. Investigation concluded that the etiology lay in a subacute sclerosing panencephalitic process attributable to the MMR II. The pt manifested no allergies to egg protein and his immediate post vaccination course had been uneventful. There had been no evidence of measles prior to the vaccination and his psychomotor development had been normal until the onset of symptoms. Subsequently, in approximately August 2001 the pt died.


VAERS ID: 180557 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Foreign  
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted: 2001-12-04
Entered: 2002-01-28
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media
SMQs:, Accidents and injuries (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-03-09
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC Split Type: 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


VAERS ID: 181512 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Indiana  
Vaccinated:2002-01-17
Onset:2002-01-19
   Days after vaccination:2
Submitted: 2002-02-11
   Days after onset:23
Entered: 2002-02-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR 3274C / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR U03442 / 3 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 488175 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Coma, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-pending Autopsy states; few petechiae of heart, thymus and lungs; early stage of decompression; no evidence of injuries; cultures are neg for pathologic organisms; blood neg for volatiles, acetaminophen and CO; blood salicylate 11.2ug/ml; urine neg for drugs
CDC Split Type:

Write-up: Informed by mom on 2/8/02 that her child was found dead in bed on 1/19/02 about 33 hours after well child visit and immunizations. No previous by us, last immunizations at 6 months. Mom reports an autopsy is being done. Per coroner''s office no autopsy was done in this county. COD as per autopsy report is undetermined. Info rec''d 4/18/02 states; The decedent was an 18 month old white male who lived with his parents. He was pronounced nonviable by medics at 08:55 upon their arrival at the residence. The child was found by his father around 08:45 to be unresponsive and 911 was called. The child was last seen alive by his mother about 23:00 of the night before when she placed him in bed after returning from a birthday party. The child has a clinic visit on 1/17 when he had 5 immunization shots and treatment for dry skin rash. There was bottles of children liquid cold medicine scattered in the kitchen but according to the mother, the infant had not had any since the last time he was sick, about 2 1/2 weeks ago. COD: undetermined.


VAERS ID: 181776 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Foreign  
Vaccinated:1995-01-19
Onset:1995-01-21
   Days after vaccination:2
Submitted: 2002-02-22
   Days after onset:2589
Entered: 2002-02-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chromosome abnormality
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bactrim; Ergenyl; valproic acid
Current Illness:
Preexisting Conditions: Chromosomal abnormality; Seizure disorder
Allergies:
Diagnostic Lab Data: Autopsy-death related to Wolf-Hirschhorn Syndrome (chromosome disorder)
CDC Split Type: WAES0202USA01840

Write-up: Information has been received from a health authority concerning a 2 year old male with Wolf-Hirschhorn Syndrome, a disease with a defection in chromosome no. 4 and epilepsy who on 1/19/95 was vaccinated SC with MMRII. Two days later on 1/21/95, the boy was found dead in his bed. It was reported that 35% of children with Wolf-Hirschhorn Syndrome will die before the age of 2 years. There was no indication per autopsy, of any other explanation for his death. The reporter felt that it was unlikely that the sudden death related to Wolf-Hirschhorn Syndrome was related to therapy with MMRII. No further information is available.


VAERS ID: 181875 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Foreign  
Vaccinated:2002-01-22
Onset:2002-01-28
   Days after vaccination:6
Submitted: 2002-12-12
   Days after onset:318
Entered: 2002-03-04
   Days after submission:283
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1321K / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Nasopharyngitis, Pharyngitis, Pyrexia, Rhinitis, Sudden infant death syndrome
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Measles + Mumps + Rubella (MMR II)~~1.50~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: Twin birth; premature birth; protrusion tongue; respiratory tract infection NOS; starbismus
Allergies:
Diagnostic Lab Data: Diagnostic lab test-Rhinovirus in nasopharynx, Haemophilus influenzae in nasopharynx; serum C-reactive protein-18; cerebrospinal fluid culture-normal; Body weight measurement, 7/25/00, 2350 grams, temp measurement, 1/28/02, 39 C; Blood culture, 1/29/02, normal.
CDC Split Type: WAES0202USA01616

Write-up: Information has been received from a consumer concerning his *18* month old twin daughter who on 1/22/02 was vaccinated with 1 dose of MMRII. After vaccination, the pt developed a common cold with fever. *It was reported that in the afternoon of 1/28/02, the PT had a fever of 39 C and was treated w/paracetamol, whereafter the fever decreased. Seven days, post vax, on 1/29/01, the pt died. The cause of death was unknown. Additional information has been requested. Follow-up info noted that Rhinovirus and Haemophilus influenzae were found in the pt''s nasopharynx, CRP 18, spinal fluid and blood culture normal. Both her adrenal glands were smaller than normal than expected for her age. The cause of death was assessed as SIDS. No further info is available. Follow up info received from a health authority indicated that the pt was not a monozygotic twin, that she had been born four weeks before term and weighed 2150 grams at birth. The pt was reportedly "somewhat behind her sister in motoric development during her first year." It was noted that eye contact could not be easily established by the doctor and strabismus was observed at 8 months of age. She also had a tendency to stick out her tongue. She was sick more often than her sister during her first year, with fever and respiratory tract infections. Following an examination on 12/12/00 it was extablished that her development was within normal limits. From one year of age the pt had no problems and was not seen by a doctor until the vaccination at 18 months of age. The pt had a good appetite and "normal growth," and when she was examined in connection with the vaccination visit she was found to be trustful with "normal development." It was noted that the pt''s twin sister was vaccinated on the same day, with the same batch, and had developed a "high fever" the day after the pt died. The pt''s mother was noted to be a non-smoker and does not drink alcohol. An autopsy report has been requested. *F/UP report on 12/19/02: F-UP info indicated that an autopsy has been done and the results showed no abnormalities. It was noted that the parents were against providing details of the autopsy.* No further info is available.


VAERS ID: 181884 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Female  
Location: New York  
Vaccinated:2002-01-25
Onset:2002-01-28
   Days after vaccination:3
Submitted: 2002-02-25
   Days after onset:28
Entered: 2002-03-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5292A2 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0736L / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Dyspnoea, Heart rate increased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-02-08
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Extensive antibiotics; prednisone
Current Illness: Advanced Cystic Fibrosis
Preexisting Conditions: Cystic Fibrosis; diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shots were given on 1/25/02. On 1/28/02, the pt had a temperature of 104F, extreme shortness of breath (requiring 10 liters of oxygen) to help alleviate. Also, had a heart rate of 180 +.


VAERS ID: 182011 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Foreign  
Vaccinated:1993-08-18
Onset:1993-12-01
   Days after vaccination:105
Submitted: 2002-03-06
   Days after onset:3017
Entered: 2002-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Bone marrow depression, Cerebral haemorrhage, Loss of consciousness, Platelet count decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Myelodysplastic syndrome (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Diagnostic radiology-showed large intra-cerebral hemorrhage; Platelet count-low on 12/93-and extremely low on 1/94-(1); Bone marrow punction-showed a toxic influence on the bone marrow, especially on the myeloposesis and the thrombopoesis.
CDC Split Type: WAES0202USA02477

Write-up: Information has been received from a journalist concerning an 18 month old female who on 8/18/93 was vaccinated with MMRII. According to her parents, low platelet counts were measured in the beginning of 12/93. Her condition deteriorated and she was referred to the hospital in 1/94 for further investigation. This investigation gave the result that her low platelet values were probably due to an idiopathic reaction and she was discharged from the hospital. However, some time thereafter, she was re-admitted due to unconsciousness. Investigation at that time, showed a large intra-cerebral hemorrhage and she was referred to Neurosurgery for further treatment in the beginning of 2/94. It was reported that there were no signs that this reaction was ITP. However, the girl died shortly thereafter due to the large intra-cerebral hemorrhage. The case was evaluated by a physician with the dept of Pediatrics. His conclusion was that "among all the cases reported with this thrombocytopenia, this case was the only one with aplastic changes". The report was assessed as possibly related to vaccination with MMRII. No further information is available.


VAERS ID: 182012 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Foreign  
Vaccinated:1983-08-31
Onset:1983-09-04
   Days after vaccination:4
Submitted: 2002-03-06
   Days after onset:6758
Entered: 2002-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Sepsis
SMQs:, Agranulocytosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1983-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0202USA02476

Write-up: Information has been received from a journalist concerning a 1 year old female who on 8/31/83 was vaccinated with MMRII. On 9/4/83, the pt died. The dx was reported as sepsis. The pt''s death was not reported to be related to the vaccination with MMRII. No further information is available.


VAERS ID: 182013 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Foreign  
Vaccinated:1989-10-01
Onset:1989-10-08
   Days after vaccination:7
Submitted: 2002-03-14
   Days after onset:4540
Entered: 2002-03-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Injury, Laboratory test abnormal, Sepsis
SMQs:, Agranulocytosis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1989-10-13
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Head computed axial tomography-general edema; blood culture-growth of staph aureaus in one of 4 samples; serum c-reactive protein-increase max 115 mg/L
CDC Split Type: WAES0202USA02475

Write-up: Information has been received regarding a report from a journalist concerning an 18 month old male who on 10/01/1989 was vaccinated with a dose of MMRII. Subsequently, the pt developed sepsis and on 10/13/89, the pt died. The reporter felt that sepsis was not related to therapy with MMRII. No further information is available. Follow-up info from the physician indicated that on 10/08/1989 the pt experienced a mild head trauma and he did not faint or seem affected. That night he experienced convulsions and was hospitalized at 3am on 10/11/1989 iwth a temp of 40 deg. C., had periphery blood circulation, superficial breathing, his heart rate was approx. 180/min and his BP could not be measured. Hypotoneness of his extremities was noted. HIs pupils showed no abnormalities and his "glucosis was 0.6." Intensive care treatment was reported, "liquor" showed no abnormalities. Growth of Staphylococcul aureus was noted in one of 4 samples. On 10/12/1989 the pt''s right pupil did not react to light and his left pupil was miotic. Emergency Ct scan of the brain showed general edema. he was transferred to another hospital facility for treatment. On the morning of 10/13/1989 the pt was brain dead and respirator treatment was stopped. The cause of death was unclear. metabolic diseases were excluded. "Antibody determination of liuor and serum for herpes, morbilli, petotitis, rubella negative." Virus isolation was negative. CRP increased to max 115mg/L and 1 positive blood test was noted. Otherwise, no basis of bacterial infection. ASA and paracetamol in serum were negative. The reported physicians "assess that it is possible that the child has some kind of sepsis that has lead to severe edema of the brain." No results were reported from the autopsy. The possibility of encephalitis caused by the vaccines will be examined. Further info received reported that the investigation pointed at sepsis.The forensic scientist assessed "that there is not causal relationshi to the vaccine." No further info is available.


VAERS ID: 182014 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Foreign  
Vaccinated:1988-04-25
Onset:1988-04-29
   Days after vaccination:4
Submitted: 2002-03-12
   Days after onset:5065
Entered: 2002-03-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Cough, Laboratory test abnormal, Lethargy, Pneumonia, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1988-05-04
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Microbiology test-growth of betaemolyzing streptocuccus group A in the lungs and resp. system
CDC Split Type: WAES0202USA02474

Write-up: Information has been received regarding a report from a journalist concerning an 18 month old male who on 4/25/88 was vaccinated with a dose of MMRII. Subsequently, the pt developed pneumonia and on 5/4/88, the pt died. The reporter felt that pneumonia was not related to therapy with MMRII. No further information is available. Follow-up info from a hospital physician indicated that on 04/29/1988 the pt developed fever which increased over the next couple of days to $g40 deg. c. On 05/03/1988 the pt experienced rhinitis and a slight cough and was lethargic. He was seen by a physician who reported that the pt ha dleft sided otitis. He was treated with cn, Nezeril drops and Alvedon. The possibility for a vaccine reaction was discussed, but the duration of fever was considered to have been more than expected. The following morning on 05/04/1988. The pt was found dead in his bed by his parents with much foaming, bloody liquid from his mouth. The autopsy showed inflammation of the lungs and respiratory system. A picture of interstitial pneumonia and peri-broncial inflammation which are seen in connection with inflammation caused by virus. Growth of betahemolyzing streptococcus group A could be measured in the lungs and respiratory system but was difficult to assess whether it contributed to his death. No trace of alcohol or pharmaceuticals was noted. The reporter felt that pneumonia was not related to therapy with MMR. No further info is available.


VAERS ID: 182015 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Foreign  
Vaccinated:1985-11-13
Onset:1985-11-17
   Days after vaccination:4
Submitted: 2002-03-14
   Days after onset:5961
Entered: 2002-03-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Petechiae, Pyrexia, Rash, Sepsis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1985-11-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Otitis media, upper respiratory infection, urinary tract infection
Allergies:
Diagnostic Lab Data: CSP differential white cell count:white 14, poly 8, mono 6; cerebrospinal fluid culture:very little growth of menigococcals all sensible to every antibiotic; throat culture:nasopharyax much pneumococcals and klebaiella
CDC Split Type: WAES0202USA02473

Write-up: Information has been received regarding a report from a journalist concerning an 18 month old female (also reported as male) who on 11/13/85 was vaccinated with a dose of MMRII. Subsequently, the pt developed sepsis and on 11/18/85, the pt died. The reporter felt that the pt''s sepsis was not related to therapy with MMRII. No further information is available. Follow-up info from a hospital physician indicated that the pt developed fever and vomiting in the afternoon on 11/17/1985. On 11/18/1985, at about three o''xlock, a blue-reddish rash in groins was spreading to generalized. The pt was hosptialized at 4:45 with widespread petechiae and no stiffness of her nek. her LP included: 173 red; 14 white; poly 8, mono6, protein 0.10 and glucose 12. Her cultures included: nasopharynx with much pneumonia and klebsiella: urine -0 and blood-0. Liquor: showed very little growth of meningococcals all sensible to every antibiotic used. The pt received intensive treatment with hydrocortisone sodium succinate and Zinacef, but the pt died at 8:50 on 11/18/1985. Section showed petechiae, swelling of the brain and bilaterally necrosis of adrenal glands. Microscopy showed masive adrenal gland bleeding and surface of cerebrum shows edemic and dry bloody meninges but not meningitis. It was reported that the pt died due to other causes than pharmaceutical and the relationship was incidental. No further info is available.


VAERS ID: 183160 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2002-03-21
Onset:2002-03-22
   Days after vaccination:1
Submitted: 2002-03-30
   Days after onset:8
Entered: 2002-04-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2002-05-01
   Days after onset: 39
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


VAERS ID: 184346 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: California  
Vaccinated:2002-04-04
Onset:2002-04-27
   Days after vaccination:23
Submitted: 2002-05-01
   Days after onset:4
Entered: 2002-05-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2002-07-16
   Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 44 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC Split Type:

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


VAERS ID: 184466 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2002-03-05
Onset:2002-03-18
   Days after vaccination:13
Submitted: 2002-05-07
   Days after onset:49
Entered: 2002-05-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA610AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0160L / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484209 / 2 RL / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Bacterial infection, Brain oedema, Cerebral haemorrhage, Hypersensitivity
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Hyponatraemia/SIADH (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? Yes
   Date died: 2002-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pink throat and slightly enlarged tonsils and stuffy nose per F/U 6/10/02
Preexisting Conditions: Mom reported vomiting and diarrhea that stopped 4 days prior to death; went to ER per F/U 6/10/02, also has history of allergies
Allergies:
Diagnostic Lab Data: Autopsy performed-cause of death; nodular pneumonitis with allergic component
CDC Split Type: LA020501

Write-up: The pt died suddenly at the babysitter''s; dx on death certificate is nodular pneumonitis with allergic component. Mother is concerned that child''s allergic reaction was possibly related to vaccine. Received HIB, MMR, PCV-7 on 3/5/02. Per F/U 6/10/02 also had cerebral edema and congestion, scattered colonies of bacterial-type elements within these nodular areas and intra-alveolar hemorrhage.


VAERS ID: 184904 (history)  
Form: Version 1.0  
Age: 2.08  
Sex: Male  
Location: Foreign  
Vaccinated:2001-05-16
Onset:2001-06-03
   Days after vaccination:18
Submitted: 2002-05-14
   Days after onset:345
Entered: 2002-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Conjunctival disorders (narrow), Ocular infections (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-06-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC Split Type: WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


VAERS ID: 187045 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2002-07-05
Entered: 2002-07-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Coma, Encephalitis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Other Medications:
Current Illness:
Preexisting Conditions: Hospitalization
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0206USA01625

Write-up: Information has been received from a physician concerning a pt who was vaccinated with a dose of MMR II. The reporter "heard" that the pt "may have had a serious adverse event" and requested information regarding MMR II, encephalitis and coma. Unspecified medical attention was sought; however, the reporting physician noted that the pt was "not his pt." The reporter considered the adverse event to be an other important medical event. Additional info has been requested. Follow-up info was received on 06/27/02. The physician revealed that he is acting as a consutant on a legal case concerning this pt. He reported that she went on to develop encephalitis and later died. The reporter considered the encehalitis to be an other important medical event. Additional info has been requested.


VAERS ID: 187688 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Unknown  
Location: Foreign  
Vaccinated:2001-11-22
Onset:2001-11-27
   Days after vaccination:5
Submitted: 2002-10-10
   Days after onset:316
Entered: 2002-07-17
   Days after submission:85
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cystitis, Pyelonephritis
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: Autopsy - subacute cystitis with a focus of acute pyelonephritis in the left kidney; Diagnostic lab test - haemoculture sterile; Spinal Tap - sterile (All done on 11/27/01.
CDC Split Type: WAES0206USA02446

Write-up: Information has been received from a health authority concerning a 15 month old patient who on 11/22/2001 was vaccinated with the first dose of MMRII vaccine. On 11/27/01, the patient died. An autopsy revealed a subacute cystitis with a focus of acute pyelonephritis in the left kidney. The physician who reported the case to the health authority concluded that this disorder was not the cause of death. Lab results included: sterile Haemoculture and spinal fluid. No further information is available. dollow up information indicated that the patient was being treated with Priorix not MMRII (MSD) as previously reported. Therefore WAES#0206USA02446 is being deleted from our files for MMRII


VAERS ID: 188465 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2002-08-02
Entered: 2002-08-06
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Hypersensitivity
SMQs:, Angioedema (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0207USA02659

Write-up: Information has been received from a consumer concerning a female who was vaccinated on an unknown date with a dose of MMR II (lot not given). The reporter stated "a little girl up the street died after an allergic reaction to MMR." It was also indicated that it was unknown if the pt sought medical attention. Additional info has been requested.


VAERS ID: 189358 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Nevada  
Vaccinated:2002-04-16
Onset:2002-04-26
   Days after vaccination:10
Submitted: 2002-08-23
   Days after onset:119
Entered: 2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2002-10-25
   Days after onset: 182
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC Split Type:

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


VAERS ID: 189882 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:1997-06-12
Onset:1997-06-12
   Days after vaccination:0
Submitted: 2002-09-03
   Days after onset:1909
Entered: 2002-09-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Chromosome abnormality, Drug administration error, Lethargy
SMQs:, Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-09-25
   Days after onset: 1201
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


VAERS ID: 190452 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2002-09-17
Entered: 2002-09-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unk
Current Illness:
Preexisting Conditions: Immunodeficiency NOS
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0209USA00733

Write-up: Information has been received from a physician concerning a male (age not given), who was vaccinated on an unknown date with a dose of MMR vaccine live (second generation) (lot # not given). At the time of vaccination the patient had an unknown immune deficiency. Following vaccination, the patient developed a morbilliform rash and fever, got better, then developed another morbilliform rash and fever for 3-4 days, the a serious illness. The patient had been diagnosed on an unknown date with hematophagocytic syndrome, and Epstein Barr virus was found. The patient had also been hospitalized on an unknown date. The patient died (cause unknown) on an unknown date. It was noted that this case took place some years ago, and had to do with a child. Morbilliform rash, fever, serious illness, hematophagocytic syndrome, Epstein Barr virus and the unknown cause of death were considered to be immediately life-threatening. Additional information has been requested.


VAERS ID: 192483 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Foreign  
Vaccinated:1994-10-13
Onset:0000-00-00
Submitted: 2002-10-30
Entered: 2002-11-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1037W / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autism, Gastrointestinal disorder, Hydroureter, Psychomotor hyperactivity
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (narrow), Dementia (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0210USA02146

Write-up: Information has been received regarding a case in litigation concerning a male child who on 10/13/94, at the age of 12 months was vaccinated with a dose of MMR II (lot 609861/1037W; batch 850672). It is alleged that following the vaccination the pt developed Asperger''s syndrome and bowel problems. Upon internal review the pt''s Asperger''s syndrome and bowel problems were considered to be other important medical events (OMIC). No further info is available. A 15-day follow up report received 3/10/2003 adds: Information has been received concerning a 13 month old male child with mild asthma, mild hydroureteronephrosis and a medical history of clicking hips, bilateral ureteric reflux, and meconium staining of the liquor during during, who on 10/13/1994 was vaccinated with a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (Lot #609861/1037W: Batch #950672 (diluent)). It is alleged that following the vaccination the pt developed Asperger''s syndrome, Attention Deficit Disorder with Hyperactivity, and Lymphoid Nodular Hyperplasia in the terminal ileum. Additional info was received and indicted that the pt was crying, screaming and writhing about on one afternoon during the week post vaccination. This was unusual, as the pt never behaved like this before. Within 6 weeks post vaccination, the pt began to pick up his toys one after the other, look at them and then throw them away. He was no longer playing appropriately with them. Also the pt was extremely restless. He was not seeking out the company of adults as he had done before. He started to throw heavy objects around the house. Also within 8 weeks, his speech patterns had changed and from conversational cadences to being less talkative and expressing himself in a kind of gibberish that did not sound like conversational attempts. Within 3 to 4 months, his sleep patterns completely changed. He now needed little sleep, during which he was restless and twitchy. Within approximately 6 months, the pt had developed an obsession with the same audio and videocassettes. He would play then 30 or 40 times over and over again. If they were turned off, he would scream for hours. Within 6 months, the pt was displaying many typical autistic traits. He had gradually begun hand wringing and having temper tantrums. He had also lost all of his eye contact gradually in the 6 months post vaccination. He did not want to be near familiar people and developed a severe dislike of strangers. He would arch his body and go completely rigid if he was somewhere that he was uncomfortable with. In February 1997, the pt was seen by a pediatrician and was diagnosed as having attention deficit disorder with hyperactivity. He was prescribed methylphenidate (RITALIN) which made his condition worse and so he was brought off it after 3 months. On 05/07/1998, the pt was diagnosed with Asperger''s syndrome. Following continuous bouts of constipation for a period of around 12 months, the pt was seen and referred by a general practitioner on 06/16/1999. The pt underwent a colonoscopy on 05/16/2000 and the specialist in pediatric gastroenterology made a diagnosis of Grade 2 lymphoid nodlar hyperplasia in his terminal ileum with loss of vascular pattern up to the transverse colon. During the same appointment, the pt underwent an OGD (oesophagogastroduodenoscopy) that showed normal oesophagus, minimal antral erythema and duodenal erythema in ''D1''. In an assessment performed on 05/01/1997, at the age of 3.5 years old, a physician indicated that the pt''s mother had non-insulin dependent diabetes and needed insulin during pregnancy. The pt was born vaginally at 40 weeks without problems after an induction. He was an easy baby, slept a lot and was breast-fed until 8 months. He began verbalizing at about a year old and had a few words by the age 0f 2. He was talking in sentences now. His parents could not remember when the pt began to sit, crawl, stand, or walk but felt that they were within normal limits. He was an affectionate child. The pt was currently on methylphenidate (RITALIN) 5mg ''mane''. None at weekends. His parents indicated that his behavior was very destructive and had general motor over-activity. He would go around touching everything. He would interrupt others constantly and found it difficult to listen. They reported that he was generally quite easily distractible but with certain tasks, such as sitting with a book, using the computer or watching videos, he was able to maintain concentration. Mealtimes were also difficult in getting him to sit down and eat. His mother felt that the pt was more amenable since starting methylphenidate (RITALIN) with less tantrums and was more settled. His father felt that it made little difference. The pt appeared to have quite a number of ritualistic, almost obsessional behaviors. For istance, the pt insisted that he must eat this breakfast while wearing his dressing gown. He insisted that many tasks are done in a specific order and also had his own ''special tasks'' such as putting lids on bottles or putting fruit into plastic bags in the supermarket. He also appeared to have a compulsive need to touch things. He had a particular interest in books of any kind and will sit and ''read'' a book from cover to cover. He would throw a tantrum, lasting for an hour or so, if he were not allowed to finish the task. Recently, the pt had been experiencing night terrors. Toileting is another main problem. Toilet training had begun last summer and he was dry during the day to the point where he was able to wear ordinary pants but was still soiling. He appeared to be retaining his feces but constipation was ruled out as a possible cause and laxatives were of little help as he was producing small amounts often. Currently, he refused to use a pot; he said, ''I can''t''. He was back to wearing nappies full time now. He played quietly and appropriately with toys on his own for most of the interview. He seemed placid and happy. Although the pt did seem to have some of the features of ADHD (attention-deficit hyperactivity disorder), in general his behavior did not seem to have the pervasiveness that one would expect with such a diagnosis. Medication appeared to have helped with some of his behavior, but then it can also bring about improvements in concentration and ability to settle to tasks in children without such a diagnosis. Regarding his problems of soiling, if constipation has been ruled out as a cause, then it might be a behavioral expression over issue of control. A behavioral approach was suggested for toileting problems. In an assessment performed on 08/13/1997, a physician indicated that the pt was born at 40 weeks following induction. There was meconium staining of the liquor. Chicking hips were diagnosed at birth that resolved spontaneously. Bilateral ureteric reflux was also diagnosed early. Motor milestones were achieved without difficulty and the pt was walking by his first birthday. Theh 18-month check highlighted concerns about the pt''s hearing because of his speech was not making expected progress. He was starting to talk at about 2 years old. His vocabulary grew satisfactorily and sentences developed at the expected time. It was the content of his speech that was of concern and has continued to do so. The pt has no history of ENT (ear, nose, throat) problems; he recently had undergone a full audiological assessment. His inappropriate use of language such as I hungry. I''d better go to bed has been of concern. His mother suspected that he learned and recited verbatim and everything he did was parrot-fashion. He tended to find inappropriate uses for whatever he was given to play with. Formal assessment was not completed. He sat for a short while and attempted a number of tasks successfully. He then decided to get down from the table and left the room. Based on observation, his gross locomotor skills were probably age appropriate. He was a physically active, strong and energetic boy. Cognitive development appeared to be age appropriate. His personal/sociall skills were an area of concern. He dressed himself independently. He had an aversion to using the toilet and would hide when he needed to go. He could relate to other children but did not see the need for them. He paid no attention to visiting children and was very good at amusing himself. He was a messy eater. He was constantly up and down from the table during a meal and always had to dissect his sandwiches. He could use a spoon and fork independently. Hearing was within normal limits. There had been some discussion of language development earlier and of the pt''s sometimes-inappropriate use of language. He actively avoided fine motor tasks. He disliked drawing and avoided using a pencil as much as possible. In an assessment performed on 07/08/1996, a pediatrician indicated that the pt was diagnosed as having mild hydroureteronephrosis which was currently just being monitored and had no overt clinical effects. He had very mild asthma, which was well controlled. He used budesonide (PULMICORT) two puffs at night through a spacer. This was increased to two puffs in the jmorning and at night if he became wheezy. He also required albuterol (VENTOLIN) two puffs through a spacer if he became wheezy. There were no concerns about his vision but he has not had formal testing to date. He seemed to pick up very tiny details of things both near and far. He always had a problem with stool retention but was improving with a behavioral program of going to the toilet every evening. He wore diapers at night and had an occasional accident but in general his toileting during the day was problem free. Due to his disinterest, he needed help with dressing and washing.The pt was receiving help with social communication and developing his imagination. He had an exceptional memory and tended to learn language often by rote. His ability with language made him sound very mature but if asked to give an account of an event, he might provide a disjointed account. He had difficulties with conversations as he made literal interpretations and found difficulty with turn taking. His abstract understanding was also likely to be impaired, although his understanding of physical concepts such as shape, size, and color might well be ahead of his peers. He had a little concept of fear or danger and needed to be supervised. He was recently started a trial of a gluten-free diet. An immunization history indicated that the pt was vaccinated with diphtheria, pertussis, tetanus toxoid, polio and haemophilus B conjugate on 11/11/1993, 12/07/1993 and 01/11/1994. Upon internal review the pt''s Asperger''s syndrome, Attention Deficit Disorder with Hyperactivity, and Lymphoid Modular Hyperplasia in the terminal ileum were considered to be other important medical events. No further information is available. A copy of the pt''s complete medical records is available upon request.


VAERS ID: 197850 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Foreign  
Vaccinated:2002-11-26
Onset:2002-12-03
   Days after vaccination:7
Submitted: 2003-02-12
   Days after onset:71
Entered: 2003-02-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Meningitis, Pyrexia, Sensation of heaviness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-12-08
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocephalus; meningoencephalitis
Allergies:
Diagnostic Lab Data: Serum measles IgG antibody on 12/8/02, comment: no results reported, measles; Serum measles IgM antibody on 12/8/02, comment: no results reported, measles; Serum mumps IgG antibody on 12/8/02, comment: no results reported, mumps; Serum mumps IgM antibody on 12/8/02, comment: no results reported, mumps; Serum rubella IgG antibody on 12/8/02, comment: no results reported, rubella; Serum rubella IgM antibody on 12/8/02, comment: no results reported, rubella; Autopsy: big, swollen, fluid-filled and slightly asymmetric brain with thick membrane and compressed under side, content of stomach found in air pathways,
CDC Split Type: WAES0302USA00230

Write-up: Information has been received from a health authority concerning a 12 year old female who on 11/26/02 was vaccinated with a dose of MMR II. It was noted that the pt had a history of "intern hydrocephalus and signs of meningioencephalitis," but the onset of these is unclear. There was no concomitant medication. Eight days after vaccination, on 12/3/02 the pt developed a fever. On 12/8/02 the pt died (cause of death not reported). Follow up information from the health authority indicated that on 12/3/02 the patient developed numbness in her arms and legs. On 12/7/02 the patient developed a fever up to 40.3C. After contact with a doctor, the patient received penicillin treatment (tablets). On 12/8/02 the patient continued to complain about the pain in her legs and arms, and she was vomiting. The patient''s temperature decreaed to 37.3C. The patient was examined by a doctor 1/2 hour before her death. The doctor said that the patient was able to walk in her room and one could talk to her. The results of the autopsy showed, big, swollen, fluid-filled and slightly asymmetric brain with thick membrane and compressed under side. The content of the stomach has been found in the air pathways. There were no other findings. Clinical examinations showed in both lungs insignificant presence of bacteria type haemophilus haemoliticus. Intestinal bacteries type pseudomas aeruginosa was present in the normal range. Antigen examination did not show presence of meningococs type A, B, and C or pneumococcal polysaccharide. The presence of borelia IgG and IgM had not been shown. Examinations of antibody against MMR viruses showed the presence of IgG and IgM against measles and IgM against mumps but not IgG. IT was not founded any signs or acute or earlier infections with measles virus or reaction on this infection. Neuropathological examinations showed chronic changes in the brain membrane as a result of coalescence of the frontal lobe with brain membrane and brain surface reminding inflamed cell infiltration. The pattern of cell infiltration occurred along cavity forms the typical glial scar. It was reported that the chances in the brain membrane had started at least a half hear ago or for several years ago. The health authority assessment indicated that the results of the autopsy and other examinations showed that compression of the brain causes death from lack of breathing or heart stop. The changes in the brain membrane indicated that earlier cerebrospinal memingitis resulted in the formation of a cavity. The assessment noted, it is unclear if the increased fluid content in the brain was the result of MMR vaccinatoin or infection, possible influenza. However, the results of the examinations showed that the most likely, the increased fluid in the brain and resulted compression of the brain was the consequence of virus infection during earlier cerebrospinal meningitis resulting in formation of cavity in the brain. Follow up information, in the form of an autopsy report, indicated that the patient developed afever and felt well on 12/3/02 on her way home from school. The family took it to be influenza, as a number of families had had it. On 12/8/02 the patient continued to get worse, vomiting and still complaining of a sensation of heaviness and pains in her arms and legs. Post mortem findings were: stomach contents found to have been sucked down into the airways, and an large, swollen, fluid-filled and slightly asymmetrical brain with thickened meninges and signs of pressure on the underside. No pathological changes otherwise. Additional examinations indicated that a full bacteriological examination was carried out, indicating only isolated bacteria of the type haemophilus haemoliticus in both lungs, and these were not attributed any significance. Cultures were taken for pathogenic intestinal bacteria, indicating the presence of naturally occurring pseudomonas aeruginosa. No antibodies were found for rubella. It was noted that the results for mumps antibodies were consistent with a recently administered vaccination, and no previous infection with rubella, or sign of reaction ot the administered vaccine was demonstrated. The neuropathological examination revealed chronic changes, with a thickened meninx and subsequent coalescence of the frontal lobes and attaching of the meninges to the surface of the brain, plus the presence of small inflammatory cell infiltrates. Isolated inflammatory cell infiltrates were observed around the vessels and along their cavities, plus the presence of scar tissue in the form of so-called gliosis. The changes were interpreted as an existing result of a previous inflammation in the meninges and brain tissue, which had taken place at least 5 years ago, or possibly more. Brain atrophy was demonstrated and an enlarged brain cavity wsa noted. Acute fluid accumulation was also found in the brain, with signs of the cerebrum having been pressed down around the brain stem. The conclusion was that, cause of death may be assumed to be respiratory and cardiac arrest resulting from downward pressure on the brain. It was noted that changes found in the brain indicated a past meningeal and brain inflammation, with a subsequently enlarged brain cavity. It was further noted that of relevance is the finding of pronounced fluid accumulation and subsequent downward pressure from this. The extent to which fluid accumulation in the brain was caused by MMR vaccine or an infection, possibly influenza, cannot be determined with certainty, but based on antibody determinations and culture results, it is most likely that fluid accumulation and subsequent downward pressure on the brain arose due to a viral infection in either the previously inflamed meninges or brain (which had occasioned an enlarged brain cavity), in an already weakened 12 year old girl. It was noted that the pt was examined for IgG and IgM for measles, mumps and rubella, but no results were reported. Additional information is not expected. Case closed.


VAERS ID: 198985 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2002-01-04
Onset:2002-01-07
   Days after vaccination:3
Submitted: 2003-03-06
   Days after onset:423
Entered: 2003-03-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC Split Type:

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


VAERS ID: 199294 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2003-03-07
Entered: 2003-03-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coma, Convulsion, Haemorrhage intracranial, Hypotonia, Thrombocytopenia, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), 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 (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Imaging studies revealed subdural hemorrhage; physical examination flaccid and unresponsive; platelet count 50x10 to the 9/L
CDC Split Type: WAES0302CAN00126

Write-up: Information has been received from three physicians publishing an article titled "Thrombocytopenia after immunization of children, 1992 to 2001" concerning a 13 month old male who was vaccinated between 1992 to 2001 with MMR II. Subsequently the pt experienced thrombocytopenia and was hospitalized 6 days post therapy with MMR II. The authors reported that the pt was previously well but had fallen down a few stairs three days prior to hospitalization. On the day of admission the pt had vomited and had a seizure. A physical examination was done that revealed the pt to be flaccid and unresponsive. Subsequently, imaging studies of his head revealed a subdural hemorrhage and a blood platelet count of 5x10 to the 9/1. The pt was treated with four units of platelets, one dose of hydrocortisone and two doses of IV immunoglobulin. Within a few hours of being hospitalized the pt died. The authors felt that the cause of death was intracranial haemorrhage nos. No further info is available.


VAERS ID: 201354 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted: 2003-04-08
Entered: 2003-04-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), 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? Yes
   Date died: 2001-10-03
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


VAERS ID: 202332 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2003-02-01
Onset:2003-02-06
   Days after vaccination:5
Submitted: 2003-04-28
   Days after onset:80
Entered: 2003-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / 2 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 - / -
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR - / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Coma, Hypertrophy
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: See tox screening in box 7.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See box 7.
CDC Split Type:

Write-up: Active-duty soldier, 181 cm tall, 180 lbs, found unresponsive in barracks 5-6 days post smallpox vaccination. Post-mortem toxicology positive for methadones (0.26 mg/L), diazepam (0.33 mg/L), nordiazepam (0.22 mg/L), but not temazepam, alprazolam, or dextromethorphan. Autopsy revealed concentric L ventricular hypertrophy, but no myocarditis. Conclusion: Vaccination unrelated to soldier''s death.


VAERS ID: 206895 (history)  
Form: Version 1.0  
Age: 1.29  
Sex: Female  
Location: California  
Vaccinated:2003-03-17
Onset:2003-05-22
   Days after vaccination:66
Submitted: 2003-07-23
   Days after onset:62
Entered: 2003-08-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acidosis, Hepatic necrosis, Hepatitis, Renal failure, Respiratory failure, Sepsis, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2003-05-31
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200301423

Write-up: This subject is a one year old female, who was admitted to the hospital due to systemic inflammatory response syndrome while enrolled in a Phase IV Daptacel study. The subject received one dose of Daptacel vaccine: along with other pediatric vaccines on 3/17/03. The subject developed symptoms 65 days post immunization and was admitted to the hospital three days later 5/25/03. The subject was transferred from hospital to another hospital on 5/26/03 with the diagnosis of acute respiratory failure, presumed streptococcal sepsis and hepatitis. While at hospital, the pt expired on 5/31/03 with a diagnosis of SIRS, acidosis and acute liver necrosis. The event of systemic inflammatory response syndrome was reported by the investigator as unrelated to the study vaccine. No autopsy was performed. Follow up on 04/21/04: "New version created to place Infanrix into pt''s history screen." Medical Records received on 8/05/2003 states kidney failure and thrombocytopenia.


VAERS ID: 207834 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2002-11-14
Onset:0000-00-00
Submitted: 2003-08-11
Entered: 2003-08-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB245AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Military       Purchased by: Unknown
Symptoms: Bacterial infection, Cough, Drug ineffective, Dyspnoea, Laboratory test abnormal, Pharyngitis, Rash maculo-papular, Respiratory distress, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Lack of efficacy/effect (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-12-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic Laboratory: PCR was positive for Neisseria Meningococcal infection serogroup C.
CDC Split Type: 200301574

Write-up: From initial information received on 8/7/03 from a medical professional, regarding an adverse event occurring in the US, it was reported that an 18year old male patient received MENOMUNE, lot number UB245AA, FLUZONE (lot number not reported), TUBERSOL (lot number not reported), HEPATITIS A VACCINE (lot number and manufacturer not reported, HEPATITIS B VACCINE (lot number and manufacturer not reported), MMR (lot number not reported), and PNEUMOVAX (lot number not reported) administered on 11/14/02. All vaccines were administered on the same date. The patient died on 12/15/02. The CDC investigation confirmed that the patient was positive for serogroup C, Meningococcal infection. The onset date of signs and symptoms were not reported. An autopsy was performed, however, results were not available at the time of this report. Follow-up information: Information has been received from a health professional concerning an 18 year old male patient who was healthy with no adverse entry who on 11/14/2002 was vaccinated with a dose of MMRII (Lot # not reported). Concomitant therapy on 11/14/2002 included a dose of hepatitis A vaccine (inactive) (manufacturer unknown) (Lot # not reported), a dose of hepatitis B virus vaccine rHBsAg (yeast) (manufacturer unknown) (Lot # not reported), a dose of pneumococcal vaccine 23 polyvalent (MSD) (Lot # not reported), a dose of tuberculin in purified protein derivative (TUBERSOL) (Lot # not reported), a dose of influenza virus vaccine (FLUZONE) (Lot # not reported) and a dose of meningococcal polysaccharide vaccine (MENOMUME-A/C/Y/W-135) (Lot # UB245AA). Subsequently the patient died on 12/15/2002. It was confirmed that the patient was positive for serogroup C Meningococcal infection. The onset date of signs and symptoms were not reported. An autopsy was performed; however, the results were not available at the time of the report. From additional information received on 08/12/2003 from a pathology department, it was reported that the patient presented with an acute onset of a rash on his feet that spread to his face over a period of a few hours, after a 3 day history of a cough and sore throat. The symptoms progressed rapidly to severe respiratory distress and shock. The patient was treated with advanced cardiac life support in the ICU (intensive care unit) and died within three hours of presenting to the hospital. The patient died at 1:01 pm on 12/15/2002; the autopsy was done the following day and showed that the cause of death was Neisseria Meningitidis Septicemia (Meningococcemia). Gross autopsy findings included evidence acute shock syndrome with diffuse petechia and hemorrhage to multiple organs, visceral congestions, shock kidneys, and a blothcy erythematous rash to the organs and a few scattered foci of acute inflammation within the myocardium and meninges. The clinical presentation, autopsy findings, and laboratory PCR results were consistent with Neisseria Meningitidis (meningococcal) Septicemia (special pathogens branch # M10158). The manner of death was natural. The CDC confirmed that the patient was positive for serogroup C Meningococcal infection. Final anatomical diagnosis from the autopsy report included: Diffuse discrete petechiae and small hemorrhages involving multiple organs, serosa and mucosal surfaces (intestines, mesentery, epicardium, myocardium, renal cortex, adrenals, lungs, pharynx, bronchi, skeletal muscle and conjuctica), pulmonary edema and visceral congestion, bilateral pleural and pericardial effusions, blotchy erythematous rash on face, trunk, arms and legs, shock kidneys with diffuse pale cortices. there was no purulent meningeal exudates present. The PCR results were positive for Neisseria Meningitidis Serogroup C. Microscopic findings included: Numerous fibrin micro thrombi in heart, lungs, liver, glomeruli, brain and oropharynx and scattered small foci of acute inflammation in meninges and myocardium associated with hemorrhage and focal myocyte necrosis. Microscopic descriptions included: Trachea-diffuse mucosal and submucosal hemorrhage without inflammation. Lung-diffuse alveolar damage with numerous scattered fibrin and conspicous granulocytes present in red pulp. Liver-sinusoidal congestion with sinusoids distended by granulocytes and scattered fibrin micro thrombi. Prostate and bladder-mucosal and glandular autolysis, no pathologic diagnosis. There were no radiographs taken. Toxicology results included: Volatiles-the blood and vitereous fluid were examined for the presence of ethanol at a cutoff of 20 mg/dl. No ethanol was detected. The following drugs were detected: Positive Lidocaine-Lidocaine was detected in the liver by gas chromatography and confirmed by gas chromatography/mass spectrometry. Positive Atropine-Atropine was detected in the liver by gas chromatography/mass.


VAERS ID: 209467 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2003-09-17
Entered: 2003-09-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Gastrooesophageal reflux disease
SMQs:, Gastrointestinal nonspecific dysfunction (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:
Other Medications:
Current Illness:
Preexisting Conditions: Premature birth; Gastric disorder
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0309USA00381

Write-up: Information has been from an internet new site concerning a male infant, born prematurely at 28 weeks and suffers from a rare stomach disorder, who was vaccinated with a dose of MMR (second generation) (date unknown). Secondary suspect therapy included poliovirus vaccine inactivated (unspecified) (date unknown). The news report stated that "The patient who was born prematurely at 28 weeks suffered a rare stomach disorder. It meant that highly gastric contents entered his airways. But a top surgeon said that the infant suffered the unfortunate coincidence of undergoing immunization before he died while he was being bottle fed by his mother. A consultant neurosurgeon at a hospital, said he believed the immunization could have depressed the patient''s natural instinct to attempt to reject the milk. A pathologist from a hospital, said he was sceptical about any links between jabs and the death. But he said that the consultant neurosurgeon was better qualified to evaluate the risk than himself. On Tuesday, the Coroner recorded a verdict of accidental death after the patient, inhaled some gastric contents. She added: "I was thinking about recording the proximity of the immunization but probably it is too uncertain for me to say that. "But obviously, it is something important that health care practitioners will want to consider. File to be completed. Additional information is not expected.


VAERS ID: 212888 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2003-11-17
Entered: 2003-11-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis
SMQs:, Noninfectious encephalitis (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0311USA01281

Write-up: Information has been received from a newspaper article. A male pt, with no reported relevant history, was vaccinated on an unspecified date with a dose of MMR II. The article reported that over the eighteen months following vaccination the p developed subacute sclerosing panencephaltiis and lost the ability to do everything. It was reported that the pt died at 18 years of age from subacute sclerosing panencephalitis. The exact date of death was not specified. No further info is available. Case is closed.


VAERS ID: 213168 (history)  
Form: Version 1.0  
Age: 1.42  
Sex: Male  
Location: California  
Vaccinated:2003-06-30
Onset:2003-07-14
   Days after vaccination:14
Submitted: 2003-11-24
   Days after onset:133
Entered: 2003-12-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 530A2 / 4 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1236M / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0975M / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Brain neoplasm malignant, Collapse of lung, Neuroblastoma, Pleural effusion, Pneumonia, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-09-01
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-rays: 7/28/03: at 21:48 hrs-show bilateral extensive pleural effusions and areas of pulmonary edema or pneumonia. 7/28/03 at 22:34 hrs-show bilateral pleural effusions and progressive diffuse pulmonary opacification, consistent with pulmonary edema, pulmonary hemorrhage, ARDS or severe diffuse pneumonia. Feeding tube is in the stomach. Tube is in the trachea. Broviac catheter is in the right atrium. 23:33 hrs-indicatiosn: respiratory failure. Status post drainage of bilateral pleural effusions with pigtail catheters. Continued diffuse pulmonary disease.
CDC Split Type: 200303028

Write-up: This subject is a 17 month old male, who was noted to have vomiting and an abdominal mass while enrolled in a Comparative post-marketing safety study of CPDT Vaccine Adsorbed administered with other recommended vaccines according to the standard of care, at 2, 4, and 6 months of age in infants and as a booster to toddlers, Protocol Number P3T08. The subject received four doses of Infanrix. The last dose prior to the event was given on 6/30/03. Other vaccines given on the same date were IPV, PRP-T, MMR and VZV. The subject developed vomiting and an abdominal mass was found, 14 days post-immunization. The subject underwent a tumor biopsy on 7/25/03, along with bone marrow aspirations and biopsies. The pt was diagnosed as a stage 4 Neuroblastoma and was started on the COG A3973 protocol. According to the protocol, the pt was due to have a stem cell harvest after two cycles of chemotherapy. The subject was to have a future autologous stem cell transplant if enough stem cells were harvested and other requirements of the protocol has been completed. There was unanimous agreement among the transplant committee that this subject was a candidate for a stem cell transplant assuming the subject remained on the COG protocol, and the subject met transplant criteria. The subject died on 9/1/03. The event of neuroblastoma, secondary brain/ spine cancer, anoxic brain damage, pneumonia, and pulmonary collapse was reported by the investigator as not related to the study vaccine. Autopsy is pending. A 15-day follow up report received 12/19/2003 adds no new info.


VAERS ID: 213825 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Michigan  
Vaccinated:2003-05-22
Onset:2003-06-05
   Days after vaccination:14
Submitted: 2003-12-04
   Days after onset:182
Entered: 2003-12-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Bacterial infection, Brain oedema, Bronchitis, Pneumonia
SMQs:, Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-06-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


VAERS ID: 214003 (history)  
Form: Version 1.0  
Age: 2.7  
Sex: Female  
Location: Foreign  
Vaccinated:2003-02-28
Onset:2003-02-28
   Days after vaccination:0
Submitted: 2003-12-10
   Days after onset:285
Entered: 2003-12-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. C2831 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Laboratory test abnormal, Neoplasm, Pyrexia, Sarcoma
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-11-27
   Days after onset: 272
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:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Ultrasound: there is a low echo area where an artery passes through. Diagnostic pathological examination: parvicellular malignant tumor probably originated from granulocytic sarcoma. Bone biopsy: eosinophilic granulocyte increased, neutrophil alkaline phosphatase increased. Body temp 38.5 C. WBC normal. Hemoglobin decreased. Lymphocyte count normal. Neutrophil count normal; Platelet count decreased.
CDC Split Type: WAES0312CHN00004

Write-up: Information has been received from a physician concerning a 34 month old girl who at 1:00 PM, 2/28/03 was vaccinated with MMR, 0.5 ml, IM. In the evening of 2/28/03, the girl experienced fever with 38.5 of body temperature. At 7:00 PM, 2/28/03, the girl developed a 0.5x0.5cm square of mass around her right ear. On 5/1/03, she was placed on fomentation therapy (detail unknown) for the treatment of the mass under doctor''s suggestion. On 3/25/03, the girl recovered from fever. On 4/29/03, the girl was hospitalized because the mass increased to 4x2cm square. The physical examination showed the mass was middle texture with clear borderline, coarse surface and limited mobility. At the time, the result of her blood examination revealed 7.7 of white blood cell count, 35.1 of blood lymphocyte count, 59.4 of blood neutrophil count, 2.7 of blood platelet count and 100 of blood hemoglobin. On the same day, her right ear ultrasound result showed there was a low echo area where an artery passes through. On 4/30/03, the girl was diagnosed with parvicellular malignant tumor in right parotid gland via diagnostic pathological examination. The physician estimated the parvicellular malignant tumor probably originated from granulocytic sarcoma in lymphatic and hematopoietic system. On 5/9/03, the result of her bone biopsy revealed her eosinophilic granulocyte and neutrophil alkaline phosphatase were increased. On 11/27/03, the girl died because of parvicellular malignant tumor in right parotid gland. The reporting physician felt the girl''s parvicellular malignant tumor in right glad region was definitely not related to the vaccination with MMR. Additional information is not expected.


VAERS ID: 214715 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:1998-06-02
Onset:0000-00-00
Submitted: 2004-01-02
Entered: 2004-01-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0238E / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

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:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0312USA02390

Write-up: Information has been received from an attorney concerning a pt who on 6/2/98 was vaccinated with a dose of hep B virus vaccine. Other reported vaccinations included a dose of MMR II (620003/0238E). Subsequently the pt experienced death. The cause of death was death unexplained. Additional info will be provided as it becomes available.


VAERS ID: 215919 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Missouri  
Vaccinated:2003-12-09
Onset:2003-12-11
   Days after vaccination:2
Submitted: 2004-01-29
   Days after onset:49
Entered: 2004-02-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-12-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: None. Had diarrhea 2 weeks before.


VAERS ID: 216187 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2004-02-03
Entered: 2004-02-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Heart rate increased, Hypotension, Hypoxia, Infection, Laboratory test abnormal, Pneumonia, Pyrexia, Rash papular, Respiratory disorder, Tachypnoea
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (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:
Other Medications: Antineoplastic (unspecified)
Current Illness:
Preexisting Conditions: Acute lymphobalstic leukaemia; T-cell count decreased; chemotherapy
Allergies:
Diagnostic Lab Data: Chest x-ray: day 5: diffuse bilateral infiltrate; blood pressure measurement; chest x-ray: prominent interstitial pattern bilaterally, particularly mid and lower lung fields; immunofluorescence antigen testing both lungs: parainfluenza virus type 3 detected; bronchial irrigation: pending: fungal, mycobacterial, legionella, mycoplasma pneumoniae cultures; bronchial irritation: negative direct staining for bacteria, fungi, P carinii, acid-fact bacilli, Legionella pneumophila; renal function study: normal; endotracheal tube culture: coagulase-negative staphylococci; blood pressure measurement: hypotension; autopsy; chest x-ray: bilateral, diffuse mixed interstitial and airspace, SC emphysema most evident in left axilla; WBC count 11.2 x 10 9/L; absolute neutrophil count 8.6, 11,400/mm3; arterial blood O2 sat 94%; body temp 39.1 C, 40 C; hemoglobin 106 g/L; platelet count 44 x 10 9/L; vital sing 30 breaths/min; blood culture: negative; nasal culture: positive for parainfluenza virus type 3; wound culture: lip: herpes simplex type 1; serum L-lactate test: lactic acidosis; cytomegalovirus antibody screen: negative: urine and buffy coat; bronchial culture: bacterial culture negative; total heartbeat count 148 beats/min; hepatic function tests: normal; urine culture: negative.
CDC Split Type: WAES0401CAN00086

Write-up: Information has been received from a physicians publishing article, January 2004 titled "Fever and Respiratory Distress in an 8 year old boy Receiving Therapy for Acute Lymphoblastic Leukemia," "Measles Vaccination" concerning an 8 year old male with acute lymphoblastic leukaemia, T-cell count decreased and chemotherapy was in remission by day 28 and had received his last dose IV chemotherapy therapy 2 weeks prior hospitalization, who in approximately 1988 was vaccinated with MMR II. The boy was previously a healthy boy. In 1995, the pt was hospitalized in a local hospital with a history of fever for a week and tachypnea and respiratory distress for 24 hrs. Therapy with ceftazidime and topical therapy was initiated on his upper lip for a cold sore. Blood culture and urine culture were negative. At day 5 of hospitalization, the pt experienced persistent high fever, hypoxemia and a deteriorating mental status. A chest x-ray demonstrated diffuse bilateral infiltrates. The pt was transferred to a hospital. On admission to the hospital, the pt had the following vital signs: body temp: 39.1 C, heart rate: 148 beats/min; oxygen sat 94% on room air, blood pressure: 90/50mmHg. The pt''s ears were red, with fluids. Examination demonstrated dry, slightly red and crusty conjunctivae and few scattered petechiea, several slightly raised, slightly red papules on skin on hand and back. No lymphadenopathy or hepatosplenomegaly were noted. Liver and renal function were normal. The pt also had the following test results: Hemoglobin: 106g/l, white blood cell count: 11.2 x 10 9/L, absolute neutrophil count: 8.6, platelets: 44 x 10 9/L, chest x-ray: prominent interstitial pattern bilaterally, particularly in the mid and lower lung fields. Therapy with piperacillin, gentamicin and high dose of trimethoprim/ sulfamethoxazole was initiated followed by IV acyclovir the next day. The following day a nasopharyngeal swab demonstrated a positive result for Parainfluenza virus type 3. The pt was still febrile (40 C) 2 days later. The pt need in oxygen increased. The pt had an absolute neutrophil count of 11,400/mm3. The pt was admitted to the ICU and received bilevel-positive airway pressure. A bronchoalveolar lavage demonstrated negative staining for bacteria, fungi, Pneumocystis carinii, acid-test bacilli and Legionella pneumophila. Result were pending on fungal, mycobacterial and legionella and Mycoplasma pneumonia cultures. Immunofluorescence antigen testing on both lungs was positive Parainfluenza virus type 3. Herpes simplex type 1 was present in a scraping of the lip, coagulase-negative staphylococci grew on an endotracheal tube culture and urine and buffy coat were negative for cytomegalovirus. The pt was intubated 2 days later because of increasing hypoxia. Therapy with amphotericin-B was initiated empirically because of persistent fever and furosemide for positive fluid balance, decreased urinary output and ''wet-looking" lungs. Diffuse air space and interstitial disease with pneumomediastinum and SC emphysema, most evident in the left axilla were noted on chest x-ray the next day. Therapy with dopamine was initiated to maintain good perfusion, therapy with acyclovir was discontinued and therapy with ganciclovir was initiated. A second bronchoalveolar lavage confirmed the findings of the first one. The pt stayed febrile and was difficult to ventilate over the course of the next several days. The pt became more and more hypotensive and developed lactic acidosis despite liquid ventilation with a perfluorocarbon emulsion containing oxygen. Decision was made to not pursue further aggressive treatment and therapy with dopamine was discontinued. The pt died 18 days after hospitalization. An autopsy was performed. "The cause of death was clearly the recent measles infection causing the giant cell pneumonia with diffuse damage to the lining epithelium of the respiratory tract from trracheal to alveolar levels." The authors also stated that the "believed that the single dose of vaccine failed to protect our pt and possibly the sibling (see WAES0401CAN00087). We believed that the child with leukemia likely had depression of T-cell function as a result of chemotherapy" and further believe that he developed measles in part because he received only a single dose of vaccine, but that the infection proved fatal because of immunosupression." No further info is available.


VAERS ID: 217129 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: California  
Vaccinated:2004-02-26
Onset:2004-02-26
   Days after vaccination:0
Submitted: 2004-03-02
   Days after onset:5
Entered: 2004-03-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21893B9 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0915N / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0178N / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493505 / 2 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0196N / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Adrenal haemorrhage, Bacterial infection, Crying, Heart disease congenital, Pyrexia, Sepsis, Shock, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Congenital, familial and genetic disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2004-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 1/2 tab per day (baby Aspirin)
Current Illness: NONE
Preexisting Conditions: Cardiac heterotaxy; Dextrocardia; Complete AV Septal defect; Pulmonary Atresia
Allergies:
Diagnostic Lab Data: blood culture (+) for streptococcus pneumoniae;
CDC Split Type:

Write-up: According to family, 3 hours after immun