|
VAERS ID: |
25003 (history) |
Form: |
Version 1.0 |
Age: |
0.8 |
Gender: |
Male |
Location: |
Texas |
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Delirium,
Hypokinesia,
Hypotonia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
|
VAERS ID: |
25530 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Gender: |
Male |
Location: |
Indiana |
Vaccinated: | 1990-06-04 |
Onset: | 1990-06-04 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
262913 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Pyrexia,
Sudden infant death syndrome SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-05
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no relevant hx, no siblings Allergies: Diagnostic Lab Data: CDC Split Type: 9001011.01
Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS |
|
VAERS ID: |
25535 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Gender: |
Male |
Location: |
Ohio |
Vaccinated: | 1990-03-28 |
Onset: | 1990-03-28 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271962 / 2 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
259949 / 2 |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-03-28
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy revealed no pathology in any organ system that could explain the death of this infant, therefore, this is a case of sudden death syndrome. CDC Split Type: 9000592.01
Write-up: normal 4 moth old infant received DTP/OPV in office at on 28Mar90, put to bed at 10:00pm; found dead at 10:30 pm. |
|
VAERS ID: |
25543 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Gender: |
Unknown |
Location: |
Wisconsin |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Diarrhoea,
Respiratory disorder SMQs:, Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 9001123.01
Write-up: 4 month old infant received first DTP/OPV immun. & had no immediate problems, was apparently well & healthy. 9-10 days later, developed repiratory symptoms & diarrhea, then found dead the following day. |
|
VAERS ID: |
25553 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Gender: |
Male |
Location: |
Tennessee |
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9J01114 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Adrenal cortex necrosis,
Adrenal haemorrhage,
Lung disorder,
Neoplasm,
Petechiae,
Pulmonary oedema,
Stupor,
Ventricular fibrillation SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (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: none Current Illness: routine well baby checkup given Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM. |
|
VAERS ID: |
25556 (history) |
Form: |
Version 1.0 |
Age: |
|
Gender: |
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: |
25683 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Gender: |
Female |
Location: |
Missouri |
Vaccinated: | 1990-06-29 |
Onset: | 1990-07-02 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271911 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0603F / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-07-02
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: hx of infantile apnea syndrome Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor. |
|
VAERS ID: |
25703 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Gender: |
Female |
Location: |
Virginia |
Vaccinated: | 1990-06-26 |
Onset: | 1990-06-26 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
235944 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-26
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: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS |
|
VAERS ID: |
25780 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Gender: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-07-26 |
Onset: | 1990-07-28 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-07-29
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No previous seizures in pt. No hx of seizures in parents and/or siblings. Allergies: Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested CDC Split Type: 9001336.01
Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival. |
|
VAERS ID: |
25870 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Gender: |
Male |
Location: |
California |
Vaccinated: | 1990-08-24 |
Onset: | 1990-08-25 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
279947 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
61706 / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Pyrexia,
Stupor SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV became irritable, body temp 100.f. No vomiting or other symptoms; Fell asleep at 6AM when parents went to wake him for feeding noted to be unresponsive. Paramedics were called brought to ER. |
|