|
| VAERS ID: |
25556 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
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:, Sepsis (narrow), Opportunistic infections (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: |
25994 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Male |
| Location: |
Wyoming |
| Vaccinated: | 1989-12-05 |
| Onset: | 1989-12-29 |
| Days after vaccination: | 24 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-09-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256957 / 4 |
- / L |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2068P / 1 |
- / L |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
298B1 / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Asphyxia,
Brain oedema,
Immune system disorder,
Infection,
Necrosis,
Pulmonary haemorrhage,
Pulmonary oedema,
Splenomegaly SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Pedizole, Tassi Organdin Current Illness: Otitis, Bronchitis Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy was contradictory /w no conclusions & many signs of Pertussis reactions. CDC Split Type:
Write-up: Casey was given DPT/MMR/OPV while still on anitbiotic Pedizole and tassii organdin for otitis & bronchitis. He appeared happy & well until he died in his sleep. Shots were given on 5DEC89. |
|
| 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: |
27526 (history) |
| Form: |
Version 1.0 |
| Age: |
0.5 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 1990-12-22 |
| Onset: | 1990-12-31 |
| Days after vaccination: | 9 |
| Submitted: |
0000-00-00 |
| Entered: |
1991-01-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea,
Bronchitis,
Cardiac failure,
Coagulopathy,
Convulsion,
Infection,
Pharyngitis,
Pneumonia,
Pyrexia,
Rash,
Renal failure,
Sepsis,
Shock SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Oropharyngeal infections (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), Chronic kidney disease (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? 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES91010158
Write-up: Developed T,convuls&pneumonia.Hospitalized w/ septic shock, renal failure & disseminated intravascular coagulation.Develop rash&tracheitis.Culture-Staph aureus.Exp multiple system failure-renal/respiratory/metabolic/cardivascul.Died 11Jan91 |
|
| VAERS ID: |
28906 (history) |
| Form: |
Version 1.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 1989-12-08 |
| Onset: | 1989-12-27 |
| Days after vaccination: | 19 |
| Submitted: |
1991-02-27 |
| Days after onset: | 427 |
| Entered: |
1991-03-08 |
| Days after submission: | 9 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1471P / 1 |
LA / SC |
Administered by: Public Purchased by: Public Symptoms: Headache SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1989-12-27
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: Finlepsen (Carbamazepine) Current Illness: NONE Preexisting Conditions: Epilepsy listed in autopsy as basic cause of death. Allergies: Diagnostic Lab Data: pt did not seek medical attention. No tests performed p/vax was administered. CDC Split Type:
Write-up: Five days p/MMR vax was administered, pt experienced recurring headaches which continued until her death. |
|
| VAERS ID: |
29978 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Male |
| Location: |
Pennsylvania |
| Vaccinated: | 1991-02-14 |
| Onset: | 1991-03-10 |
| Days after vaccination: | 24 |
| Submitted: |
1991-04-16 |
| Days after onset: | 36 |
| Entered: |
1991-04-19 |
| Days after submission: | 3 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M200FD / 1 |
RA / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1880S / 1 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Pyrexia,
Rhinitis,
Sudden infant death syndrome SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect; CDC Split Type:
Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91; |
|
| VAERS ID: |
34373 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1991-04-17 |
| Onset: | 1991-04-20 |
| Days after vaccination: | 3 |
| Submitted: |
1991-04-22 |
| Days after onset: | 2 |
| Entered: |
1991-08-29 |
| Days after submission: | 129 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M705FE / 1 |
LA / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1570S / 1 |
RA / - |
Administered by: Public Purchased by: Public Symptoms: Drug ineffective,
Hypotonia,
Meningitis,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-04-21
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Aplitest by Parke-Davis lot# 01990P lt forearm Current Illness: neg Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis CDC Split Type: NYS91064
Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM; |
|
| VAERS ID: |
34471 (history) |
| Form: |
Version 1.0 |
| Age: |
8.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 1991-08-13 |
| Onset: | 1991-08-14 |
| Days after vaccination: | 1 |
| Submitted: |
1991-08-23 |
| Days after onset: | 9 |
| Entered: |
1991-09-03 |
| Days after submission: | 11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1343S / 2 |
LA / SC |
Administered by: Public Purchased by: Public Symptoms: Acidosis,
Convulsion,
Haemorrhage,
Marrow hyperplasia,
Necrosis,
Petechiae,
Splenomegaly,
Thrombotic thrombocytopenic purpura SMQs:, Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Renovascular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-08-20
Days after onset: 6
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: Current Illness: few petechia on back, abd, legs Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: GA91239
Write-up: Mom called 19AUG91 reporting pt started w/diarrhea, fever? (no thermometer), sleeping a lot on 14AUG91; rash on 18AUG91 & was advised to seek med eval that day; Did not go for care until pt collapsed @ home p/MN; Taken to ER, where pt died; |
|
| VAERS ID: |
35477 (history) |
| Form: |
Version 1.0 |
| Age: |
5.0 |
| Sex: |
Male |
| Location: |
Louisiana |
| Vaccinated: | 1991-09-26 |
| Onset: | 1991-09-26 |
| Days after vaccination: | 0 |
| Submitted: |
1991-09-30 |
| Days after onset: | 4 |
| Entered: |
1991-10-14 |
| Days after submission: | 14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
1L21055 / 4 |
LA / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1904S / 2 |
RA / SC |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
304966 / 5 |
MO / PO |
Administered by: Public Purchased by: Unknown Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-09-26
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient Other Medications: Current Illness: None known; Preexisting Conditions: Sz disorder, microcephaly, & mental retardation; Allergies: Diagnostic Lab Data: Unknown; CDC Split Type: LA911001
Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91; |
|