|
| VAERS ID: |
856698 (history) |
| Form: |
Version 2.0 |
| Age: |
0.17 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2020-01-13 |
| Onset: | 2020-01-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-01-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
K7TF9 / 1 |
RL / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
S000355 / 1 |
LL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
AA7118 / 1 |
LL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
4PP5L / 1 |
MO / PO |
Administered by: Military Purchased by: ?
Symptoms: Chest X-ray,
Death
SMQs:
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:
Other Medications: VITAMIN D DROPS 10 MCG/ML-400 UNITS PER ML HYDROCORTISONE CREAM 1% APPLY TO AFFECTED AREAS 2 TO 3 TIMES DAILY TO AFFECTED AREAS EMOLLIENT BASE CREAM TOPICAL APPLY AFFECTED AREAS TWICE A DAY ON BODY AND FACE FOR DRY SKIN ESOMEPRAZOLE MAG 2.
Current Illness: NEWBORN RASH V/S ATOPIC ECZEMA V/S MILARIA RUBRA "NOISY BREATHING" REFERRAL PLACED TO ENT
Preexisting Conditions: NONE
Allergies: NO KNOWN DRUG ALLERIES
Diagnostic Lab Data: AN X-RAY WAS DONE THE DAY OF WELL BABY EXAM FOR "NOISY BREATHING". A REFERRAL WAS PLACED FOR PATIENT BY THE PROVIDER TO AN ENT FOR EVALUATION. THIS IS THE DAY THE VACCINES WERE ADMINISTERED.
CDC Split Type:
Write-up: PARENT REPORTED INFANT DEATH. PATIENT WAS FOUND IN CRIB, FACE DOWN DECEASED ON 01/13/2020 IN THE AFTERNOON. |
|
| VAERS ID: |
857105 (history) |
| Form: |
Version 2.0 |
| Age: |
75.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-01-08 |
| Onset: | 2020-01-10 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS |
24KZ7 / 2 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-01-10
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: PATIENT PASSED AWAY 2 DAYS AFTER RECEIVING VACCINATION |
|
| VAERS ID: |
857115 (history) |
| Form: |
Version 2.0 |
| Age: |
1.08 |
| Sex: |
Female |
| Location: |
Montana |
| Vaccinated: | 2020-01-14 |
| Onset: | 2020-01-16 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
UJ058AB / 4 |
RL / SYR |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT6647JA / 1 |
RL / SYR |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
R013540 / 3 |
LL / SYR |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
AL8457 / 1 |
LL / SYR |
Administered by: Private Purchased by: ?
Symptoms: Cardio-respiratory arrest,
Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-01-16
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: Acetaminophen (Tylenol) 160 mgi/5mL Solution
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient arrived to hospital by EMS, CPR in progress. On arrival, patient had no spontaneous cardiac activity or respirations. |
|
| VAERS ID: |
857584 (history) |
| Form: |
Version 2.0 |
| Age: |
60.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-01-01 |
| Onset: | 2020-01-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-01-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
QS 2019-20 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Death,
General physical health deterioration,
Laboratory test,
Life support,
Organ failure,
Pneumonia,
Sepsis
SMQs:, 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 (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-01-11
Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen Albuterol Benzonatate Ipratropium-Albuterol Ketorolac Sodium Chloride Anti Depressant
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10 Days on life support with constant tests, no improvement, quick decline. Currently obtaining full records.
CDC Split Type:
Write-up: Given while ill with fever and flu. Quick deterioration. Lung and blood infection. Sepsis within 24 hours. Life support with organ failure. Death in one week time. |
|
| VAERS ID: |
857879 (history) |
| Form: |
Version 2.0 |
| Age: |
45.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2020-01-23 |
| Onset: | 2020-01-24 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-01-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
UNKNOWN / UNK |
- / UN |
Administered by: Unknown Purchased by: ?
Symptoms: Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-01-26
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: uncertain
Current Illness: rheumatoid arthritis
Preexisting Conditions: rheumatoid arthritis. alcohol abuse.
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:
Write-up: seizure within 24 hours of vaccination |
|
| VAERS ID: |
858436 (history) |
| Form: |
Version 2.0 |
| Age: |
0.42 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-01-09 |
| Onset: | 2020-01-12 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-01-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
UJ126AA / 2 |
RL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
T81219 / 2 |
LL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1660112 / 2 |
MO / PO |
Administered by: Private Purchased by: ?
Symptoms: Bed sharing,
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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER. |
|
| VAERS ID: |
860135 (history) |
| Form: |
Version 2.0 |
| Age: |
0.17 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-01-29 |
| Onset: | 2020-02-01 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-02-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
UJ230AA / 1 |
LL / IM |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
LR537 / 2 |
RL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
CG9017 / 1 |
RL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1660693 / 1 |
MO / PO |
Administered by: Private Purchased by: ?
Symptoms: Cardiac arrest,
Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-02-01
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 2mg
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient passed away on 2/1/2020 ED diagnosis- cardiac arrest |
|
| VAERS ID: |
860962 (history) |
| Form: |
Version 2.0 |
| Age: |
67.0 |
| Sex: |
Male |
| Location: |
Arkansas |
| Vaccinated: | 2020-01-28 |
| Onset: | 2020-02-04 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-02-10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR |
UJ310AB / 1 |
LA / IM |
| VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS |
7RK7K / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Cardiac arrest,
Death,
Hypoxia,
Influenza,
Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-02-04
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unlnown
Diagnostic Lab Data:
CDC Split Type:
Write-up: Client passed away on 2/4/2020 at 0832 AM. Cause of death states hypoxia, respiratory failure, cardiac arrest and influenza. Unknown if the vaccines were linked to death in anyway. Reported due to close timing the vaccines were administered to death. |
|
| VAERS ID: |
861839 (history) |
| Form: |
Version 2.0 |
| Age: |
80.0 |
| Sex: |
Male |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-01-14 |
| Onset: | 2020-02-08 |
| Days after vaccination: | 25 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-02-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS |
- / 1 |
AR / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2020-03-29
Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cellcept, pyridistigmine, omeprazole, Levo dopa, carbidopa
Current Illness: Week previous to incident, stomach illness, vomiting
Preexisting Conditions: Parkinsons, Myasthenia Gravis
Allergies: penicillin, levaquin
Diagnostic Lab Data:
CDC Split Type:
Write-up: Onset of seizure, hospitalized, stabilized, seizure return, given Keppra, stabilized, returned again |
|
| VAERS ID: |
862890 (history) |
| Form: |
Version 2.0 |
| Age: |
1.08 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 2020-01-29 |
| Onset: | 2020-01-30 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-02-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Acute respiratory distress syndrome,
Adenovirus infection,
Adenovirus test positive,
Arthropathy,
Cellulitis,
Culture negative,
Cytomegalovirus infection,
Cytomegalovirus test positive,
Endotracheal intubation,
Epiglottitis,
Epstein-Barr virus infection,
Epstein-Barr virus test positive,
Herpes simplex,
Herpes simplex test positive,
Immunodeficiency,
Immunoglobulin therapy,
Immunology test,
Incisional drainage,
Lung assist device therapy,
Lymphadenitis,
Morbillivirus test positive,
Multiple organ dysfunction syndrome,
Otitis media,
Polymerase chain reaction positive,
Respiratory failure,
Respiratory syncytial virus test positive,
Roseolovirus test positive,
Stridor,
Viral infection
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (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), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-02-22
Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: measles vaccine strain positive from NP and urine, resulted 2/21
CDC Split Type:
Write-up: Patient is a previously healthy 13 month old boy who presented with respiratory failure, then developed ARDS and multiorgan dysfunction on VA ECMO, requiring vasoactive support and CRRT. Subsequently found to have multiple disseminated viral infections, including HSV, adenovirus, and low level positive CMV and EBV. Suspected immunodeficiency, workup pending. In setting of recent MMR and varicella vaccinations, critical illness, and suspected immunodeficiency, workup for disseminated vaccine strain measles sent at CDC. Positive for vaccine-strain measles from nasopharynx and urine. Patient initially presented with an otitis media on 1/30 and then re-presented with stridor and rapid respiratory failure. Evidence of epiglottic inflammation with "white dots" noted during intubation and cervical & retropharyngeal lymphadenitis. He had a respiratory PCR positive for adenovirus and RSV and serum positive for adenovirus, though not remarkably high level. EBV PCR in serum also low-level positive but serology from OSH suggestive of past infection. I&D of L neck lymphadenitis performed; cultures from lymph node I&D are negative. CT with evidence of developing retropharyngeal phlegmon. Subsequently developed knee lesion which was positive for HSV, HSV PCR from serum shows disseminated HSV at high viral levels. EBV and CMV positive at low levels, also HHV6 positive, likely represent reactivation in setting of severe illness. Based on multiple viral infections, immunology team involved and on DDX are immunodeficiencies such as TLR defects. HLH/MAS was considered and he met some criteria for this; was on anakinra and received intermittent steroid dosing. BAL cytology from 2/14 showed multinucleated giant cells. ETT quantitative RSV level pending. When measles results from NP/urine returned on 2/21, started on oral ribavirin (while pursuing IV ribavirin), high dose vitamin A, and redosed IVIG. HSV level continuing to fall. Unclear of contribution of measles vaccine strain to respiratory presentation; felt to be unclear whether represented prolonged shedding versus true pneumonia/pneumonitis. Further testing at CDC pending including measles IgM and measles PCR on deep respiratory sample. |
|
