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This is VAERS ID 403759

Case Details

VAERS ID:403759 (history)  Vaccinated:2010-09-09
Age:10.0  Onset:2010-09-17, Days after vaccination: 8
Gender:Male  Submitted:2010-10-15, Days after onset: 28
Location:New Jersey  Entered:2010-10-18, Days after submission: 3
Life Threatening? Yes
Died? Yes
   Date died: 2010-09-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0568Z UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1778Y UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURUA3058AA UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3476AA UNLA
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Death, Malaise
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.

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