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| VAERS ID: | 262780 (history) | Vaccinated: | 2006-09-06 | | Age: | 0.2 | Onset: | 2006-09-08, Days after vaccination: 2 | | Gender: | Male | Submitted: | 2006-09-09, Days after onset: 1 | | Location: | Kansas | Entered: | 2006-09-09 | |
| Life Threatening? No |
Died? Yes Date died: 2006-09-08 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: Infant multivitamin liquid with iron | | Current Illness: None | | Preexisting Conditions: Prematurity- 32 weeks gestation Twin B Breech vaginal delivery Apnea of prematurity Anemia of prematurity | | Diagnostic Lab Data: CBC performed on 08/30/2006 prior to vaccination showed WBC 8.83, Hgb 9.1, Hct 25.4, platelets 321K. Glucose during | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAP: DTAP (DAPTACEL) | AVENTIS PASTEUR | C2649AA | 0 | IM | LL | | HBHEPB: HIB + HEP B (COMVAX) | MERCK & CO. INC. | 0237F | 0 | IM | LL | | IPV: POLIO VIRUS, INACT. (IPOL) | AVENTIS PASTEUR | Y1031 | 0 | IM | RL | | PNC: PNEUMO (PREVNAR) | LEDERLE LABORATORIES | B08683E | 0 | IM | RL | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0578F | 0 | PO | | |
| Administered by: Unknown Purchased by: Unknown | Symptoms: Apnoea SMQs:, Acute central respiratory depression (narrow)
| | Write-up: Child was found apneic in his crib. EMS was contacted. Mother performed CPR. Child was pulseless when EMS arrived. Upon arrival to local hospital, child was asystolic with no response to chemical resuscitation. |
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| VAERS ID: | 263520 (history) | Vaccinated: | 2006-08-31 | | Age: | 0.1 | Onset: | 2006-09-05, Days after vaccination: 5 | | Gender: | Male | Submitted: | 2006-09-25, Days after onset: 20 | | Location: | South Carolina | Entered: | 2006-09-25 | |
| Life Threatening? Yes |
Died? Yes Date died: 2006-10-08 Days after onset: 33 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: none | | Current Illness: Fever of Unknown Origin | | Preexisting Conditions: none | | Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit. | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) | GLAXOSMITHKLINE BIOLOGICALS | AC21B047BA | 0 | IM | LL | | HIBV: HIB (ACTHIB) | SANOFI PASTEUR | UF011AA | 0 | IM | LL | | PNC: PNEUMO (PREVNAR) | PFIZER/WYETH | B08655AA | 0 | IM | RL | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0139F | 0 | PO | | |
| Administered by: Unknown Purchased by: Unknown | Symptoms: Anoxic encephalopathy,
Cardiac arrest,
Cardio-respiratory arrest,
Convulsion,
Meningitis,
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), Ischaemic cerebrovascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow)
| | Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06 |
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| VAERS ID: | 263554 (history) | Vaccinated: | 0000-00-00 | | Age: | 0.2 | Onset: | 2006-08-31 | | Gender: | Unknown | Submitted: | 2006-09-22, Days after onset: 22 | | Location: | West Virginia | Entered: | 2006-09-26, Days after submission: 4 | |
| Life Threatening? Yes |
Died? Yes Date died: 2006-08-31 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: UNK | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus. | | CDC 'Split Type': WAES0609USA03169 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | | 0 | PO | | |
| Administered by: Other Purchased by: Other | Symptoms: Respiratory distress,
Viral infection SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad)
| | Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available. |
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| VAERS ID: | 263568 (history) | Vaccinated: | 2006-09-12 | | Age: | 0.3 | Onset: | 2006-09-21, Days after vaccination: 9 | | Gender: | Female | Submitted: | 2006-09-21, Days after onset: 0 | | Location: | North Carolina | Entered: | 2006-09-26, Days after submission: 5 | |
| Life Threatening? No |
Died? Yes Date died: 2006-09-21 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: NONE | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': NC06086 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0139F | 0 | PO | | |
| Administered by: Private Purchased by: Public | Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
| | Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06 |
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| VAERS ID: | 264995 (history) | Vaccinated: | 2006-09-20 | | Age: | 0.1 | Onset: | 2006-10-13, Days after vaccination: 23 | | Gender: | Male | Submitted: | 2006-10-17, Days after onset: 4 | | Location: | New York | Entered: | 2006-10-20, Days after submission: 3 | |
| Life Threatening? No |
Died? Yes Date died: 2006-10-13 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAP: DTAP (TRIPEDIA) | AVENTIS PASTEUR | | | IM | UN | | HBHEPB: HIB + HEP B (COMVAX) | MERCK & CO. INC. | | 1 | IM | UN | | IPV: POLIO VIRUS, INACT. (IPOL) | AVENTIS PASTEUR | | | SC | UN | | PNC: PNEUMO (PREVNAR) | LEDERLE LABORATORIES | | | IM | UN | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0847F | | PO | | |
| Administered by: Private Purchased by: Private | Symptoms: Coma,
Sudden infant death syndrome SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow)
| | Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am. |
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| VAERS ID: | 265462 (history) | Vaccinated: | 2006-10-02 | | Age: | 0.1 | Onset: | 2006-10-02, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2006-10-19, Days after onset: 17 | | Location: | Washington | Entered: | 2006-10-27, Days after submission: 8 | |
| Life Threatening? No |
Died? Yes Date died: 2006-10-04 Days after onset: 2 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: NONE | | Current Illness: | | Preexisting Conditions: Born premature 3 weeks 1 day early and low birth weight. | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAP: DTAP (NO BRAND NAME) | UNKNOWN MANUFACTURER | | 0 | | | | HEP: HEP B (NO BRAND NAME) | UNKNOWN MANUFACTURER | | 1 | | | | HIBV: HIB (NO BRAND NAME) | UNKNOWN MANUFACTURER | | 0 | | | | IPV: POLIO VIRUS, INACT. (NO BRAND NAME) | UNKNOWN MANUFACTURER | | 0 | | | | PNC: PNEUMO (PREVNAR) | LEDERLE LABORATORIES | | 0 | | | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | | 0 | PO | | |
| Administered by: Private Purchased by: Other | Symptoms: Coma,
Fatigue,
Irritability SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
| | Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death. |
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| VAERS ID: | 266239 (history) | Vaccinated: | 2006-10-17 | | Age: | 0.2 | Onset: | 0000-00-00 | | Gender: | Male | Submitted: | 2006-11-07 | | Location: | California | Entered: | 2006-11-08, Days after submission: 1 | |
| Life Threatening? No |
Died? Yes Date died: 2006-10-23 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: NONE | | Current Illness: | | Preexisting Conditions: Birth HX: Birth: 8 lbs, 12 oz, ht 21, head circ 16. Noted to have a rash on initial exam. Dx Infant dermatitis & treated. OB/GYN of mother records from pcp reveals Mom was 23yo, g4, p2 with PMH of gonorrhea & chlamydia, HSV I & II, Grp B strep. | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) | GLAXOSMITHKLINE BIOLOGICALS | AC21B065AA | 0 | IM | RL | | HIBV: HIB (ACTHIB) | SANOFI PASTEUR | UE009AB | 0 | IM | RL | | PNC: PNEUMO (PREVNAR) | PFIZER/WYETH | B08653R | 0 | IM | LL | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0776F | 0 | PO | | |
| Administered by: Other Purchased by: Other | Symptoms: Dehydration,
Diarrhoea,
Gastroenteritis,
Maternal condition affecting foetus,
Vomiting SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Foetal disorders (narrow)
| | Write-up: On call doctor was called on 10/23/06 that the pt was brought to ER (hospital) and pt was dead already. History of diarrhea and vomiting. 11/14/06 Received medical records from PCP including med record from OB/GYN of mother which reveals Mom was 23yo, g4, p2 with PMH of gonorrhea & chlamydia, HSV I & II, Grp B strep. Developed thrush on 8/25/06 visit & treated. On 10/17 date of vax visit weight was 12 lbs 9 oz, length 23, head 15.5. Child was noted to be healthy at that time. 6/12/07 Received autopsy report which reveals COD as dehydration due to gastroenteritis & manner of death as natural. Dehydration from severe diarrhea was contributing factor. Parent reported patient had been vomiting along w/diarrhea since 10/21 (received vaccines on 10/17). Parent also admitted to use of drugs (crank) up until her 5th month of pregnancy when prenatal care began. Parent reported that allergy to formula may have been contributory as patient was on his 3rd type of formula. Coroner investigation reveals no milk allergy was reported in pcp medical records. |
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| VAERS ID: | 267630 (history) | Vaccinated: | 2006-10-20 | | Age: | 0.2 | Onset: | 2006-10-21, Days after vaccination: 1 | | Gender: | Female | Submitted: | 2006-11-16, Days after onset: 26 | | Location: | New Hampshire | Entered: | 2006-11-22, Days after submission: 6 | |
| Life Threatening? Yes |
Died? Yes Date died: 2006-10-21 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: UNK | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': WAES0611USA02595 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) | GLAXOSMITHKLINE BIOLOGICALS | AC21B070AA | 0 | IM | RL | | HIBV: HIB (ACTHIB) | SANOFI PASTEUR | UE932AA | 0 | IM | LL | | PNC: PNEUMO (PREVNAR) | PFIZER/WYETH | B086918 | 0 | IM | LA | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0577F | 0 | PO | | |
| Administered by: Other Purchased by: Other | Symptoms: Abnormal sleep-related event,
Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
| | Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined. |
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| VAERS ID: | 268705 (history) | Vaccinated: | 2006-12-04 | | Age: | 0.2 | Onset: | 2006-12-05, Days after vaccination: 1 | | Gender: | Male | Submitted: | 2006-12-06, Days after onset: 1 | | Location: | Pennsylvania | Entered: | 2006-12-12, Days after submission: 6 | |
| Life Threatening? No |
Died? Yes Date died: 2006-12-05 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: NONE | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) | GLAXOSMITHKLINE BIOLOGICALS | AC21B069AA | 0 | | LL | | HIBV: HIB (PEDVAXHIB) | MERCK & CO. INC. | 0276F | 0 | | RL | | PNC: PNEUMO (PREVNAR) | LEDERLE LABORATORIES | B08672D | 0 | | RL | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0726F | 0 | PO | | |
| Administered by: Private Purchased by: Public | Symptoms: Coma,
Sudden infant death syndrome SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow)
| | Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome. |
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| VAERS ID: | 269004 (history) | Vaccinated: | 2006-12-04 | | Age: | 0.2 | Onset: | 2006-12-09, Days after vaccination: 5 | | Gender: | Male | Submitted: | 2006-12-13, Days after onset: 4 | | Location: | Virginia | Entered: | 2006-12-18, Days after submission: 5 | |
| Life Threatening? No |
Died? Yes Date died: 2006-12-09 Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: NONE | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAP: DTAP (DAPTACEL) | SANOFI PASTEUR | C2627AA | 0 | | LL | | PNC: PNEUMO (PREVNAR) | PFIZER/WYETH | B08649A | 0 | | RL | | ROTHB5: ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 0389F | 0 | PO | | |
| Administered by: Private Purchased by: Public | Symptoms: Brain oedema,
Death of relative,
Laboratory test abnormal,
Paracentesis eye abnormal,
Rib fracture,
Strabismus,
Sudden infant death syndrome,
Unresponsive to stimuli SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteoporosis/osteopenia (broad), Ocular motility disorders (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)
| | Write-up: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage. |
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