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This is VAERS ID 402154

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 402154
VAERS Form:
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 12/7/2010

VAERS ID: 402154 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 1/4/2011

VAERS ID: 402154 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 4/13/2011

VAERS ID: 402154 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: 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, Cardiac failure congestive, Chest X-ray abnormal, Computerised tomogram normal, CSF culture positive, CSF glucose normal, CSF lymphocyte count abnormal, CSF pressure increased, CSF protein normal, Death, Diarrhoea, Disseminated intravascular coagulation, Fibrin D dimer increased, Haematocrit decreased, Haemoglobin decreased, Headache, Hepatic congestion, Hypotension, International normalised ratio increased, Interstitial lung disease, Lactic acidosis, Lethargy, Livedo reticularis, Lumbar puncture, Lupus nephritis, Lymphocyte count decreased, Malaise, Meningitis meningococcal, Nausea, Neck pain, Neutropenia, Pancytopenia, Pericardial effusion, Platelet count decreased, Pleural effusion, Prothrombin time prolonged, Pyrexia, Red blood cells CSF positive, Sepsis, Septic shock, Tachycardia, Thrombocytopenia, Thrombosis, Vomiting, White blood cell count decreased, Mental status changes, Brain oedema, Spleen congestion, Lymphocyte percentage decreased, CSF monocyte count decreased, CSF neutrophil count increased, Body height below normal, CSF test abnormal, Haemorrhagic ovarian cyst, Sputum abnormal, Blood test abnormal, Scan brain, Endotracheal intubation, Accessory spleen, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 5/13/2011

VAERS ID: 402154 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: 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, Cardiac failure congestive, Chest X-ray abnormal, Computerised tomogram normal, CSF culture positive, CSF glucose normal, CSF lymphocyte count abnormal, CSF pressure increased, CSF protein normal, Death, Diarrhoea, Disseminated intravascular coagulation, Fibrin D dimer increased, Haematocrit decreased, Haemoglobin decreased, Headache, Hepatic congestion, Hypotension, International normalised ratio increased, Interstitial lung disease, Lactic acidosis, Lethargy, Livedo reticularis, Lumbar puncture, Lupus nephritis, Lymphocyte count decreased, Malaise, Meningitis meningococcal, Nausea, Neck pain, Neutropenia, Pancytopenia, Pericardial effusion, Platelet count decreased, Pleural effusion, Prothrombin time prolonged, Pyrexia, Red blood cells CSF positive, Sepsis, Septic shock, Tachycardia, Thrombocytopenia, Thrombosis, Vomiting, White blood cell count decreased, Mental status changes, Brain oedema, Spleen congestion, Lymphocyte percentage decreased, CSF monocyte count decreased, CSF neutrophil count increased, Body height below normal, CSF test abnormal, Haemorrhagic ovarian cyst, Sputum abnormal, Blood test abnormal, Scan brain, Endotracheal intubation, Accessory spleen, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2017

VAERS ID: 402154 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
Entered:2010-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / 0 1 RA / UN

Administered by: Other      Purchased by: Public
Symptoms: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 402154 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 402154 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 402154 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 402154 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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.


Changed on 10/14/2018

VAERS ID: 402154 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Wyoming
Vaccinated:2005-09-08
Onset:2010-04-21
Submitted:2010-10-06
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: Death, Diarrhoea, Hypotension, Nausea, Neck pain, Pyrexia, Sepsis, Tachycardia, Vomiting, CSF test abnormal, Blood test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? 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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