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This is VAERS ID 397858

Case Details

VAERS ID: 397858 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2010-01-11
Onset:2010-05-18
   Days after vaccination:127
Submitted: 2010-09-09
   Days after onset:114
Entered: 2010-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2932AA / UNK UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Death, Eosinophilic myocarditis, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-05-18
   Days after onset: 0
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: not known
CDC Split Type:

Write-up: Acute Necrotizing Eosinophilic Myocarditis. Patient died at home.


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