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This is VAERS ID 200387

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 200387
VAERS Form:
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH 5178A2 / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, UB034AA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: MENINGITIS, LAB TEST ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 12/8/2009

VAERS ID: 200387 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH SMITHKLINE BEECHAM 5178A2 / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, AVENTIS PASTEUR UB034AA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Laboratory test abnormal, Meningitis, MENINGITIS, LAB TEST ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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 was positive for ? of meningitis group C. Patient was hospitalized for 4 days, then died on 2/18/03.


Changed on 5/14/2017

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

Administered by: Unknown      Purchased by: Unknown
Symptoms: Laboratory test abnormal, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 9/14/2017

VAERS ID: 200387 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5178A2 / 2 3 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB034AA / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Laboratory test abnormal, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 2/14/2018

VAERS ID: 200387 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 6/14/2018

VAERS ID: 200387 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 8/14/2018

VAERS ID: 200387 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 9/14/2018

VAERS ID: 200387 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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.


Changed on 10/14/2018

VAERS ID: 200387 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Georgia
Vaccinated:2001-07-02
Onset:0000-00-00
Submitted:2003-03-26
Entered:2003-03-28
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-02-18
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? Yes, days: 4     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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