| VAERS ID: |
402154 (history) |
| Form: |
Version 1.0 |
| 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 / 1 |
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), Arthritis (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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. |
