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This is VAERS ID 397858

History of Changes from the VAERS Wayback Machine

First Appeared on 9/22/2010

VAERS ID: 397858
VAERS Form:
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
Entered:2010-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2932AA / - UN / UN

Administered by: Military      Purchased by: Military
Symptoms: Death, Eosinophilic myocarditis, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 4/13/2011

VAERS ID: 397858 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
Entered:2010-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2932AA / - UN / UN

Administered by: Military      Purchased by: Military
Symptoms: Aspiration, Death, Dizziness, Dyspnoea, Eosinophilic myocarditis, Myocardial infarction, Pulmonary congestion, Pulmonary oedema, Unresponsive to stimuli, Drug screen negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 5/13/2011

VAERS ID: 397858 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
Entered:2010-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2932AA / - UN / UN

Administered by: Military      Purchased by: Military
Symptoms: Aspiration, Death, Dizziness, Dyspnoea, Eosinophilic myocarditis, Myocardial infarction, Pulmonary congestion, Pulmonary oedema, Unresponsive to stimuli, Drug screen negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 6/14/2014

VAERS ID: 397858 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
Entered:2010-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2932AA / - UN / UN

Administered by: Military      Purchased by: Military
Symptoms: Death, Eosinophilic myocarditis, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 4/14/2017

VAERS ID: 397858 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
Entered:2010-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2932AA / - UN / UN

Administered by: Military      Purchased by: Military
Symptoms: Death, Eosinophilic myocarditis, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 9/14/2017

VAERS ID: 397858 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 2/14/2018

VAERS ID: 397858 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 6/14/2018

VAERS ID: 397858 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 8/14/2018

VAERS ID: 397858 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 9/14/2018

VAERS ID: 397858 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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.


Changed on 10/14/2018

VAERS ID: 397858 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2010-01-11
Onset:2010-05-18
Submitted:2010-09-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-18
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? 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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