|
VAERS ID: |
25026 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
229974 / UNK |
- / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
9A11092 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
244970 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-01-14
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio |
|
VAERS ID: |
25028 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1989-05-24 |
Onset: | 1990-06-24 |
Days after vaccination: | 396 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8L01022 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Meningitis SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-25
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: CDC Split Type:
Write-up: Pt admitted with H-Flu meningitis on 24Jun90. Pt expired on 25Jun90. Pt received HIB vaccine at 18 months of age. |
|
VAERS ID: |
25534 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1987-12-09 |
Onset: | 1990-06-25 |
Days after vaccination: | 929 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH |
181666 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Drug ineffective,
Infection SMQs:, Lack of efficacy/effect (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-06-25
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: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 9001160.01
Write-up: 4 1/2 yr old child 25Jun90/w positive blood culture for h. Influenzae type B. Child received immunization on 9Dec87 |
|
VAERS ID: |
25799 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1988-09-28 |
Onset: | 1988-10-01 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Brain oedema,
Cerebral haemorrhage,
Coagulopathy,
Convulsion,
Meningitis,
Respiratory disorder,
Sepsis SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (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: hx of croup once in 08/87; Congenital hip dysplasia Allergies: Diagnostic Lab Data: CDC Split Type: CO3592
Write-up: Haemophilus influenzae, type B meningitis & sepsis. Complications; seizures, cerebral edema, intracerebral bleed, DIC & ARDS. |
|
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: |
26592 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 1990-10-03 |
Onset: | 1990-10-26 |
Days after vaccination: | 23 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11070 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (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: Estrace Cream Current Illness: Preexisting Conditions: Premature birth 2lbs 13 oz Allergies: Diagnostic Lab Data: Autopsy pending CDC Split Type:
Write-up: Pt vaccinated with PROHIBIT DOA to Hosp. |
|
VAERS ID: |
26668 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Unknown |
Location: |
New York |
Vaccinated: | 1990-11-08 |
Onset: | 1990-11-11 |
Days after vaccination: | 3 |
Submitted: |
1990-11-13 |
Days after onset: | 2 |
Entered: |
1990-11-16 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0C21132 / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Bronchitis,
Laryngitis,
Otitis media,
Pharyngitis,
Pyrexia SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-11-11
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: Current Illness: Mild cold Preexisting Conditions: normal child Allergies: Diagnostic Lab Data: CDC Split Type: CO3705
Write-up: Pt vaccinated with PROHIBIT mild cold at time of injection. Seen again 11NOV for subjective fever, worsening cold tugging at ears. Dx w/Otitis. Prescribed Augmentin, Codeine & Tylenol. Child found dead 6 hrs later in bed. Normal child |
|
VAERS ID: |
26973 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-07-17 |
Onset: | 1990-07-28 |
Days after vaccination: | 11 |
Submitted: |
1990-11-20 |
Days after onset: | 115 |
Entered: |
1990-12-12 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
9B11095 / 1 |
LA / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
275910 / 3 |
MO / PO |
Administered by: Public Purchased by: Unknown Symptoms: Acidosis,
Apnoea,
Bronchiolitis,
Cardiac arrest,
Grand mal convulsion,
Pneumonia,
Sepsis,
Shock SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (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), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1990-07-28
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: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CA9017
Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia. |
|
VAERS ID: |
27153 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Unknown |
Location: |
Ohio |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1990-12-05 |
Entered: |
1990-12-21 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / UNK |
- / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Sudden infant death syndrome SMQs:, Neonatal disorders (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CO3729
Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection. |
|