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This is VAERS ID 406995

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 406995 (history)  
Form: Version .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 / - UN / IJ

Administered by: Unknown       Purchased by: Unknown
Symptoms: Adrenal insufficiency, Death, Disseminated intravascular coagulation, Hypotension, Meningococcal infection, Meningococcal sepsis, Periorbital oedema, Petechiae, Pulmonary oedema, Shock, Thrombocytopenia, Toxicologic test normal, Waterhouse-Friderichsen syndrome
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Hypotonic-hyporesponsive episode (broad)

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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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=406995


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