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This is VAERS ID 397123

Case Details

VAERS ID: 397123 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2007-07-31
Onset:2010-06-06
   Days after vaccination:1041
Submitted: 2010-09-01
   Days after onset:87
Entered: 2010-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB179AA / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2388AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Bacteraemia, Cardiac failure, Culture positive, Neisseria test positive, Renal disorder
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2010-06-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone 60 mg every other day at time of illness (unknown if taking at time of vaccination)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Neisseria meningitidis serogroup Y isolated from blood, confirmed by culture (collection date: 6/8/2010)
CDC Split Type:

Write-up: Primary bacteremia, complications resulted in heart failure. (Note: Patient was on 60 mg prednisone every other day for kidney problems.)


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