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This is VAERS ID 170356

Case Details

VAERS ID: 170356 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Male  
Location: California  
   Days after vaccination:39
Submitted: 2001-05-23
   Days after onset:404
Entered: 2001-05-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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: 2000-04-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Chronic back pain, atherosclerosis Hx of nasal allergy, periodic HTN, rectal polyps, Hepatitis B, and ETOH abuse
Diagnostic Lab Data: Autopsy-lobes have yellow green opacified material present, consistent with purulent meningitis process.
CDC Split Type: U2001007430

Write-up: It was reported that an adult male pt received a Menomune A/C/Y/W-135 vaccination on 3/6/00. Reportedly, the pt died on 4/14/00. dx''d with purulent meningitis. Autopsy done at medical examiner''s office. Further medical follow-up is requested and ongoing. On 05/22/2001, the autopsy and medical examiners reports were received. Autopsy report revealed the following findings from the head and central nervous system. "The leptomeninges overlying the frontal lobes have yellow-green opacified material present, consistent with purulent meningitis process." From the correspondence received from a physician it was stated "This case was associated with large numbers of gram positive diplococci having the morphology consistent with S. pneumonia. A silver stain and a PAS did not support the presence of any other organism."

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