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This is VAERS ID 406995

History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 406995
VAERS Form:
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1784AA / - UN / IJ

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 4/13/2011

VAERS ID: 406995 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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, Waterhouse-Friderichsen syndrome, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/13/2011

VAERS ID: 406995 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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, Waterhouse-Friderichsen syndrome, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2017

VAERS ID: 406995 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 406995 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 406995 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 406995 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 406995 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 10/14/2018

VAERS ID: 406995 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Colorado
Vaccinated:2006-08-03
Onset:2010-10-19
Submitted:2010-11-03
Entered:2010-11-05
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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?IDNUMBER=406995&WAYBACKHISTORY=ON


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