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This is VAERS ID 170356

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 170356
VAERS Form:
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS UA160AA / - - / IM

Administered by: ??      Purchased by: Unknown
Symptoms: MENINGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
Diagnostic Lab Data: Autopsy-lobes have yellow green opacified material present, consistent with purulent meningitis process.
CDC 'Split Type':

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,


Changed on 12/30/2006

VAERS ID: 170356 Before After
VAERS Form:
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS UA160AA / - - / IM

Administered by: ??      Purchased by: Unknown
Symptoms: MENINGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
Diagnostic Lab Data: Autopsy-lobes have yellow green opacified material present, consistent with purulent meningitis process.
CDC 'Split Type':

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 dx''''d with purulent meningitis. Autopsy done at medical examiner''s examiner''''s office. Further medical follow-up is requested and ongoing."On 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 /"The leptomeninges overlying the frontal lobes have yellow-green opacified material present, present


Changed on 12/8/2009

VAERS ID: 170356 Before After
VAERS Form:
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA160AA / - - / IM

Administered by: ??      Purchased by: Unknown (blank)
Symptoms: Meningitis, MENINGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
Diagnostic Lab Data: Autopsy-lobes have yellow green opacified material present, consistent with purulent meningitis process.
CDC 'Split Type': (blank) 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 dx''d with purulent meningitis. Autopsy done at medical examiner''''s examiner''s office. Further medical follow-up is requested and ongoing". 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 "The leptomeninges overlying the frontal lobes have yellow-green opacified material present 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."


Changed on 5/14/2017

VAERS ID: 170356 Before After
VAERS Form:
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / - - / IM

Administered by: (blank) Unknown      Purchased by: (blank) Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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."


Changed on 9/14/2017

VAERS ID: 170356 Before After
VAERS Form:(blank) 1
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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."


Changed on 2/14/2018

VAERS ID: 170356 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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."


Changed on 6/14/2018

VAERS ID: 170356 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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."


Changed on 8/14/2018

VAERS ID: 170356 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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."


Changed on 9/14/2018

VAERS ID: 170356 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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."


Changed on 10/14/2018

VAERS ID: 170356 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:California
Vaccinated:2000-03-06
Onset:2000-04-14
Submitted:2001-05-23
Entered:2001-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES UA160AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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
Allergies:
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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