|
VAERS ID: |
43601 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1992-05-15 |
Onset: | 1992-06-14 |
Days after vaccination: | 30 |
Submitted: |
1992-07-05 |
Days after onset: | 21 |
Entered: |
1992-07-20 |
Days after submission: | 15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0238V / 1 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M185HF / 1 |
LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
G0123 / 1 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1992-06-14
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: fluoriode drops, Proventil inhaler Current Illness: undergoing eval for resp prob Preexisting Conditions: atrial septal defect; known obstructive hydronephrosis Allergies: Diagnostic Lab Data: post mortem; CDC Split Type:
Write-up: found dead in crib; |
|
VAERS ID: |
52579 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 1993-04-15 |
Onset: | 1993-04-16 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1993-05-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
2F41092 / UNK |
- / - |
HEP: HEP B (FOREIGN) / MERCK & CO. INC. |
1555V / UNK |
- / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M025JE / UNK |
- / - |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
G0083 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea,
Bradycardia,
Cardiac arrest,
Haematemesis,
Hypoventilation,
Pallor SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: APAP Current Illness: Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA; Allergies: Diagnostic Lab Data: aminophylline; CDC Split Type:
Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs); |
|
VAERS ID: |
53484 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1993-05-19 |
Onset: | 0000-00-00 |
Submitted: |
1993-05-20 |
Entered: |
1993-06-01 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
2H31039 / 2 |
LL / IM |
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER |
68515OK / 2 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M100HP / 2 |
RL / IM |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
G0210 / 2 |
LL / IM |
Administered by: Public Purchased by: Public Symptoms: Anorexia,
Apnoea,
Cardiac arrest,
Cough,
Petechiae,
Rhinitis,
Sudden infant death syndrome SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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 (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1993-05-20
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: IL93082
Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation; |
|
VAERS ID: |
56175 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1993-07-23 |
Onset: | 1993-08-10 |
Days after vaccination: | 18 |
Submitted: |
1993-09-14 |
Days after onset: | 35 |
Entered: |
1993-09-20 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
3J41061 / 1 |
RA / IM |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
J0225 / 1 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Condition aggravated,
Infection,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient Other Medications: TB-PPD lederle lot# 350924; Current Illness: 1st NONE-2nd Leukemia Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test; CDC Split Type:
Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect; |
|
VAERS ID: |
58900 (history) |
Form: |
Version 1.0 |
Age: |
0.1 |
Sex: |
Male |
Location: |
New Hampshire |
Vaccinated: | 1993-10-13 |
Onset: | 1993-10-21 |
Days after vaccination: | 8 |
Submitted: |
1993-12-20 |
Days after onset: | 60 |
Entered: |
1994-01-10 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
355901 / 1 |
LL / IM |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0460W / 2 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M110KA / 1 |
RL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
G0489 / 1 |
LL / IM |
Administered by: Private Purchased by: Public Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1993-10-21
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: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: NH93028
Write-up: SIDS 21OCT93; |
|
VAERS ID: |
63834 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1994-06-06 |
Onset: | 1994-06-07 |
Days after vaccination: | 1 |
Submitted: |
1994-06-10 |
Days after onset: | 3 |
Entered: |
1994-06-24 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
4H51058 / 2 |
LL / - |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1693W / 3 |
RL / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
J0690 / 2 |
RL / - |
Administered by: Private Purchased by: Public Symptoms: Apnoea,
Cyanosis SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-06-07
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: Bactrim Current Illness: NONE Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch; Allergies: Diagnostic Lab Data: blood & organ cultures-results pending; CDC Split Type: MD94018
Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94; |
|
VAERS ID: |
64863 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1994-06-27 |
Onset: | 1994-06-27 |
Days after vaccination: | 0 |
Submitted: |
1994-07-05 |
Days after onset: | 8 |
Entered: |
1994-07-22 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
355901 / 1 |
LL / IM |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0417W / 1 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M010KD / 1 |
RL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
J0690 / 1 |
LL / SC |
Administered by: Private Purchased by: Public Symptoms: Agitation,
Apnoea,
Hypotonia,
Pallor,
Stupor SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1994-06-28
Days after onset: 1
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: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt recvd vax & went home midly fussy & 4 to 6 hrs later p/feeding & being laid supine was found limp/pale/apnic; irritable, cry, pale, unresponsive, not breathing |
|
VAERS ID: |
65748 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1994-06-06 |
Onset: | 1994-06-07 |
Days after vaccination: | 1 |
Submitted: |
1994-07-29 |
Days after onset: | 52 |
Entered: |
1994-08-03 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
4H51058 / 2 |
- / IM |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1693W / 3 |
- / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
J0690 / 2 |
- / SC |
Administered by: Private Purchased by: Public Symptoms: Apnoea,
Cyanosis SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-06-07
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Bactrim Current Illness: Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd Allergies: Diagnostic Lab Data: No relevant data CDC Split Type: WAES94070425
Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested; |
|
VAERS ID: |
79601 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Utah |
Vaccinated: | 1995-11-03 |
Onset: | 1995-11-04 |
Days after vaccination: | 1 |
Submitted: |
1995-11-07 |
Days after onset: | 3 |
Entered: |
1995-11-28 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH |
428039 / 1 |
LL / IM |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
1664B2 / 2 |
RL / IM |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
L0227 / 1 |
RL / SC |
Administered by: Private Purchased by: Private Symptoms: Cyanosis,
Stupor SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1995-11-04
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Dimetapp, APAP Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: baby found blue & unresponsive |
|
VAERS ID: |
85376 (history) |
Form: |
Version 1.0 |
Age: |
0.1 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1996-04-18 |
Onset: | 1996-04-19 |
Days after vaccination: | 1 |
Submitted: |
1996-04-22 |
Days after onset: | 3 |
Entered: |
1996-04-29 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
5H61047 / 1 |
- / IM |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
1944A2 / 2 |
- / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES |
5H61156 / 1 |
- / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
K1016 / 1 |
- / SC |
Administered by: Private Purchased by: Public Symptoms: Sudden infant death syndrome,
Unevaluable event SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1996-04-19
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep |
|