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This is VAERS ID 402154

(NOTE: This result is from the 11/3/2010 version of the VAERS database)

Case Details

VAERS ID: 402154 (history)  
Form: Version .0  
Age: 13.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2005-09-08
Onset:2010-04-21
   Days after vaccination:1686
Submitted: 2010-10-06
   Days after onset:168
Entered: 2010-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / 0 RA / UN

Administered by: Other       Purchased by: Public
Symptoms: Blood test abnormal, CSF test abnormal, Death, Diarrhoea, Endotracheal intubation, Hypotension, Nausea, Neck pain, Neisseria test positive, Pyrexia, Sepsis, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2010-04-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lupus
Allergies:
Diagnostic Lab Data: Blood & CSF collected 4/21 were positive for N. meningitidis. Blood isolate was identified as serogroup Y.
CDC Split Type:

Write-up: 4/21 daytime - nausea, vomiting, diarrhea, fever & neck pain. 4/21 10:29PM At hospital ED - febrile, appearing septic & hypotensive & had tachycardia. 4/21 11:34 PM Intubated. 4/22 12:36AM Pronounced dead.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20101103&IDNUMBER=402154


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