| 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. |
