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This is VAERS ID 189974

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 189974
VAERS Form:
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, UB295AA / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: DEATH

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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:
Preexisting Conditions: PT''s sister has asthma.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From telephone contact received at manufacturer on 9/5/02, it was reported that an 18 year old male was vaccinated on 9/4/02 with Menomune A/C/Y/W-135 (lot # UB295AA). On 9/5/02, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is"being performed. **Follow-up report on 9/25/02: F/U (#1) phone call to the doctor''s office on 9/17/02: ""No info, no preliminary results"" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 wks. F


Changed on 12/8/2009

VAERS ID: 189974 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, AVENTIS PASTEUR UB295AA / - - / -

Administered by: Other Private      Purchased by: Unknown Other
Symptoms: Unevaluable event, DEATH

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: PT''s Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) U200200705

Write-up: From telephone contact received at manufacturer Aventis Pasteur Inc. on 9/5/02, 09/05/2002, it was reported that an 18 year old 18-year-old male was vaccinated on 9/4/02 09/04/2002 with Menomune A/C/Y/W-135 (lot # (lot# UB295AA). On 9/5/02, 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is"being is being performed. **Follow-up report on 9/25/02: F/U Follow-up (#1) phone telephone call to the doctor''s office Coroner''s Office on 9/17/02: ""No info, 09/17/2002: "No information, no preliminary results"" results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 wks. F weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 5/14/2017

VAERS ID: 189974 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR SANOFI PASTEUR UB295AA / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 9/14/2017

VAERS ID: 189974 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB295AA / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 2/14/2018

VAERS ID: 189974 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB295AA / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 6/14/2018

VAERS ID: 189974 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB295AA / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 8/14/2018

VAERS ID: 189974 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB295AA / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 9/14/2018

VAERS ID: 189974 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB295AA / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.


Changed on 10/14/2018

VAERS ID: 189974 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:California
Vaccinated:2002-09-04
Onset:2002-09-05
Submitted:2002-09-20
Entered:2002-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB295AA / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-09-05
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: Propecia
Current Illness: NONE
Preexisting Conditions: Family history positive for asthma, patient''s sister has asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': U200200705

Write-up: From telephone contact received at Aventis Pasteur Inc. on 09/05/2002, it was reported that an 18-year-old male was vaccinated on 09/04/2002 with Menomune A/C/Y/W-135 (lot# UB295AA). On 09/05/2002, patient''s parent called 911 after he collapsed. Patient expired. Autopsy is being performed. Follow-up (#1) telephone call to the Coroner''s Office on 09/17/2002: "No information, no preliminary results" available at this time. Investigator collected 7 doses of fluid and powder. Toxicology results will take 8-12 weeks. Family history positive for asthma. Coroner''s case number is 2002-02746. From additional correspondence received at Aventis Pasteur Inc. on 02/12/2003, it was reported that the patient with no illnesses at time of vaccination and had no pre-existing diagnosis received first dose of MENOMUNE (expiration date 10/22/2003) subcutaneously in the left arm at 15:30 on 09/04/2002. The patient was not responsive on 09/05/2002. No cause of death was determined on the preliminary coroner''s report on 09/06/2002. As per the reporter, a copy of this report has been sent to VAERS on 09/09/2002. Follow-up #2 correspondence received on 02/13/2003: From telephone contact to the Coroner''s office, the toxicology was negative and the cause of death remains undetermined. A copy of the autopsy has been requested. Reported on 03/20/2003: "From follow-up #3 information received at Aventis Pasteur Inc. on 03/07/2003, it was reported that the decendant''s Histological Examination from the autopsy report showed that the heart had few round cells in the epicardium, otherwise non-contributory. Also, on histological exam the thyroid, spleen, kidney, lung, pancreas and the liver were all non-contributory. All toxicology labs were negative. The investigator''s notes showed that the decendant had symptoms of the common cold about 3 months ago and was losing his hair, he was prescribed Propecia. Autopsy on file: Case is closed.

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