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This is VAERS ID 228893

Case Details

VAERS ID: 228893 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2004-08-28
Onset:2004-08-28
   Days after vaccination:0
Submitted: 2004-11-08
   Days after onset:72
Entered: 2004-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UE296AA / 1 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Headache, Injury, Loss of consciousness, Nasal congestion, Nausea, Pyrexia, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Patient had caught a cold on Friday and was feeling a little tried and she had alot of drainage.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: high fever, dizziness, nausea, congestion and diffculty breathing, wheezing, extremely bad headache, like a bad migraine. Patient passed out while driving her car and crossed over the highway into oncoming traffic and was killed instantly. Four different individuals have given us details of her being so sick that she couldn''t even hold her head up. 11/11/04 Medical records received from PCP. Autopsy Report received on 11/22/2004 states pt expereinced blunt force injuries.


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