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This is VAERS ID 406995

Case Details

VAERS ID: 406995 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Colorado  
Vaccinated:2006-08-03
Onset:2010-10-19
   Days after vaccination:1538
Submitted: 2010-11-03
   Days after onset:15
Entered: 2010-11-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1784AA / UNK UN / IJ

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Meningococcal infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-10-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient''s medical history was not reported.
Allergies:
Diagnostic Lab Data: Not reported.
CDC Split Type: 201006291

Write-up: Initial report received from a health care professional on 02 November 2010. A female patient (age not specified) received an injection (route and site not provided) in 2006 of MENACTRA, lot number not reported. On an unspecified date one and a half weeks ago, the patient died from group C meningococcal disease. No further information was available. Documents held by sender: None.


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