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This is VAERS ID 175648

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 175648
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD 7126AA / 0 - / SC

Administered by: Other      Purchased by: Unknown
Symptoms: VOMIT, MENINGITIS, DIARRHEA, PAIN EAR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 12/8/2009

VAERS ID: 175648 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD CONNAUGHT LTD. 7126AA / 0 - / SC

Administered by: Other      Purchased by: Unknown Public
Symptoms: Diarrhoea, Ear pain, Meningitis, Vomiting, VOMIT, MENINGITIS, DIARRHEA, PAIN EAR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 9/14/2017

VAERS ID: 175648 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD. 7126AA / 0 1 - / SC

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea, Ear pain, Meningitis, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 2/14/2018

VAERS ID: 175648 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 6/14/2018

VAERS ID: 175648 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 8/14/2018

VAERS ID: 175648 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 9/14/2018

VAERS ID: 175648 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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.


Changed on 10/14/2018

VAERS ID: 175648 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:1999-10-15
Onset:2000-12-18
Submitted:2001-09-20
Entered:2001-09-25
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-18
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: 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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