|
VAERS ID: |
416893 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 2011-02-02 |
Onset: | 2011-02-07 |
Days after vaccination: | 5 |
Submitted: |
2011-02-15 |
Days after onset: | 8 |
Entered: |
2011-02-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3665AA / 2 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0285Z / 1 |
RL / SC |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0834Z / 1 |
RL / SC |
Administered by: Public Purchased by: Public Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2011-02-07
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: Current Illness: denied by parent Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: apparently found dead in bed by parent |
|
VAERS ID: |
428370 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 2011-06-13 |
Onset: | 2011-06-20 |
Days after vaccination: | 7 |
Submitted: |
2011-07-29 |
Days after onset: | 39 |
Entered: |
2011-07-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AHAVB509AA / 2 |
LL / UN |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1643Z / 2 |
RA / UN |
Administered by: Private Purchased by: Private Symptoms: Death,
Irritability,
Pyrexia,
Unresponsive to stimuli SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2011-06-21
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap. |
|
VAERS ID: |
429528 (history) |
Form: |
Version 1.0 |
Age: |
1.25 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 2011-07-27 |
Onset: | 2011-08-06 |
Days after vaccination: | 10 |
Submitted: |
2011-08-11 |
Days after onset: | 5 |
Entered: |
2011-08-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1643Z / 1 |
LL / SC |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
1705Z / 1 |
LL / SC |
Administered by: Private Purchased by: Private Symptoms: Acidosis,
Autopsy,
Blood gases abnormal,
Death,
Laboratory test,
Pyrexia,
Respiratory arrest,
Resuscitation SMQs:, Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2011-08-08
Days after onset: 2
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: None Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10. Allergies: Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending. CDC Split Type:
Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8). |
|
VAERS ID: |
432209 (history) |
Form: |
Version 1.0 |
Age: |
48.0 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 2011-08-25 |
Onset: | 0000-00-00 |
Submitted: |
2011-08-30 |
Entered: |
2011-08-30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0103AA / 2 |
LA / SC |
Administered by: Public Purchased by: Unknown Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2011-08-27
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: NKA Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt. wife reports pt. died. |
|
VAERS ID: |
436253 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 2011-08-26 |
Onset: | 2011-08-26 |
Days after vaccination: | 0 |
Submitted: |
2011-09-29 |
Days after onset: | 34 |
Entered: |
2011-09-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C3944AA / 5 |
LL / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
UH476AC / 1 |
LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
G1083 / 4 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1644Z / 2 |
LL / IM |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
1046AA / 2 |
LL / IM |
Administered by: Public Purchased by: Other Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2011-08-26
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: Current Illness: No Preexisting Conditions: No Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient was found dead in bathroom after no obvious reaction. |
|
VAERS ID: |
436743 (history) |
Form: |
Version 1.0 |
Age: |
1.06 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 2011-09-22 |
Onset: | 2011-09-23 |
Days after vaccination: | 1 |
Submitted: |
2011-10-04 |
Days after onset: | 11 |
Entered: |
2011-10-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
UT4176BA / UNK |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0404AA / 1 |
RL / SC |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
916598 / 4 |
LL / IM |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0819AA / 1 |
LL / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Cyanosis,
Death,
Respiratory arrest SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2011-09-23
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: none Current Illness: Cold/URI/ear infection Preexisting Conditions: none Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital. |
|
VAERS ID: |
440919 (history) |
Form: |
Version 1.0 |
Age: |
1.01 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2011-10-10 |
Onset: | 2011-10-20 |
Days after vaccination: | 10 |
Submitted: |
2011-10-25 |
Days after onset: | 5 |
Entered: |
2011-11-01 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U4184BB / UNK |
RL / IM |
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS |
AHIBC291BA / UNK |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0047AA / 1 |
LL / SC |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
916922 / UNK |
RL / IM |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0338AA / 1 |
RL / SC |
Administered by: Private Purchased by: Unknown Symptoms: Asthenia,
Brain herniation,
Brain oedema,
CSF test,
Diarrhoea,
Endotracheal intubation,
Hydrocephalus,
Posturing,
Pyrexia,
Rash,
Unresponsive to stimuli,
Ventricular cisternostomy,
Viral test,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (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? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: Seckel syndrome or osteodysplastic primordial dwarfism Allergies: Diagnostic Lab Data: California encephalitis panel; CSF CDC Split Type:
Write-up: Patient with likely osteodysplastic primary dwarfism began to have vomiting, diarrhea, rash, fever on 10/20, became progressively weaker. Seen in urgent care clinic 10/23, became very weak after home on BENADRYL, came to ER. Found to have hydrocephalus (more than previous MRI), decorticate posturing, intubated, ventriculostomy perform, no longer responsive, cerebral edema and herniation. |
|
VAERS ID: |
445693 (history) |
Form: |
Version 1.0 |
Age: |
1.01 |
Sex: |
Male |
Location: |
D.C. |
Vaccinated: | 2011-11-28 |
Onset: | 2011-12-02 |
Days after vaccination: | 4 |
Submitted: |
2011-12-16 |
Days after onset: | 14 |
Entered: |
2011-12-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C39999AA / 4 |
RL / IM |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
1068AA / 1 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0513AA / 1 |
RL / SC |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
916921 / 4 |
LL / IM |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0950AA / 1 |
LL / SC |
Administered by: Unknown Purchased by: Public Symptoms: Coagulopathy,
Epistaxis,
Haemoptysis,
Peritoneal dialysis,
Platelet count decreased,
Renal failure acute,
Respiratory failure SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (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 (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen Current Illness: no Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay Allergies: Diagnostic Lab Data: unknown - evaluation at Hospital CDC Split Type:
Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date. |
|
VAERS ID: |
450453 (history) |
Form: |
Version 1.0 |
Age: |
1.07 |
Sex: |
Male |
Location: |
Maine |
Vaccinated: | 2012-02-07 |
Onset: | 2012-02-08 |
Days after vaccination: | 1 |
Submitted: |
2012-02-22 |
Days after onset: | 14 |
Entered: |
2012-02-27 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C4003AA / 4 |
RL / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
UT4149CA / 1 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0852AA / 1 |
LL / SC |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
F17155 / 1 |
LL / IM |
Administered by: Public Purchased by: Public Symptoms: Death,
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), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2012-02-08
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None known Preexisting Conditions: None known Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient found unresponsive by babysitter. EMS called to scene. Patient transported to ER at Medical Center. Time of death noted to be 20:48 on 2/8/12 by ER. |
|
VAERS ID: |
451373 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 2012-03-02 |
Onset: | 2012-03-09 |
Days after vaccination: | 7 |
Submitted: |
2012-03-09 |
Days after onset: | 0 |
Entered: |
2012-03-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0599AA / 1 |
LA / SC |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0814AA / 1 |
RA / SC |
Administered by: Private Purchased by: Private Symptoms: Autopsy,
Death,
Sudden infant death syndrome SMQs:, Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2012-03-09
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: Current Illness: Otitis - conjunctivitis syndrome dx''ed that day Preexisting Conditions: Mild dev. delay Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type:
Write-up: Unexplained crib death 7d after MMR + VARIVAX. |
|