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This is VAERS ID 175648

Case Details

VAERS ID: 175648 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:1999-10-15
Onset:2000-12-18
   Days after vaccination:430
Submitted: 2001-09-20
   Days after onset:275
Entered: 2001-09-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD. 7126AA / 1 - / SC

Administered by: Other       Purchased by: Public
Symptoms: Diarrhoea, Ear pain, Meningitis, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-12-18
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CDC did immuno-chemistry histology stains that confirmed cause of death as fulminant meningococcus. Typing was C from ear drainage. She was 19 at the age of her death.
CDC Split Type:

Write-up: Earache; diarrhea and vomiting; on menses. CDC confirmed and notified in 9/01 that the cause of death as fulminant meningococcus. Typing was C from ear drainage. Autopsy results received confirming this also.


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