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This is VAERS ID 402154

(NOTE: This result is from the 4/13/2011 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: Accessory spleen, Acute respiratory distress syndrome, Acute respiratory failure, Alanine aminotransferase increased, Ascites, Aspartate aminotransferase increased, Blood bicarbonate decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen decreased, Blood gases abnormal, Blood lactic acid increased, Blood potassium decreased, Body height below normal, Brain oedema, CSF culture positive, CSF glucose normal, CSF lymphocyte count abnormal, CSF monocyte count decreased, CSF neutrophil count increased, CSF pressure increased, CSF protein normal, CSF test abnormal, Cardiac failure congestive, Chest X-ray abnormal, Computerised tomogram normal, Death, Diarrhoea, Disseminated intravascular coagulation, Endotracheal intubation, Fibrin D dimer increased, Haematocrit decreased, Haemoglobin decreased, Haemorrhagic ovarian cyst, Headache, Hepatic congestion, Hypotension, International normalised ratio increased, Interstitial lung disease, Lactic acidosis, Lethargy, Livedo reticularis, Lumbar puncture, Lupus nephritis, Lymphocyte count decreased, Lymphocyte percentage decreased, Malaise, Meningitis meningococcal, Mental status changes, Nausea, Neck pain, Neisseria test positive, Neutropenia, Pancytopenia, Pericardial effusion, Platelet count decreased, Pleural effusion, Prothrombin time prolonged, Pyrexia, Red blood cells CSF positive, Scan brain, Sepsis, Septic shock, Spleen congestion, Sputum abnormal, Tachycardia, Thrombocytopenia, Thrombosis, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Agranulocytosis (narrow), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Osteoporosis/osteopenia (broad)

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=20110413&IDNUMBER=402154


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