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This is VAERS ID 200387

Case Details

VAERS ID: 200387 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted: 2003-03-26
Entered: 2003-03-28
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5178A2 / 3 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB034AA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Laboratory test abnormal, Meningitis
SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-02-18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood cultures postiive for Meisseria meningitis group C
CDC Split Type:

Write-up: From initial information at manufacturer, it was reported that a 19 year old female patient received Menomune A/C/Y/W 135, UB034AA, on 7/2/01. Route/site were not reported. Patient had cultures sero group C. On 2/15/03, patient had blood cultures and was positive for ? of meningitis group C. Patient was hospitalized for 4 days, then died on 2/18/03.


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