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This is VAERS ID 421371

Case Details

VAERS ID: 421371 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Male  
Location: New Hampshire  
Submitted: 2011-04-15
   Days after onset:14
Entered: 2011-04-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Influenza like illness, Meningitis meningococcal, Neisseria test positive, Oropharyngeal pain, Pain, Rash macular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-04-06
   Days after onset: 5
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: Not reported
Diagnostic Lab Data: Relevant diagnostic tests/laboratory data was reported as positive.
CDC Split Type: 201102140

Write-up: Initial report was received on 08 April 2011 from a consumer and the following electronic lay press article. A 23 year-old male patient (also reported as 21 year-old) with no reported past medical history had received possibly in 2007 MENOMUNE A/C/Y/W-135 (lot number, route, site and date of administration not reported) and "on Friday" (01 April 2011) developed a sore throat, was achy and had flu-like symptoms that lasted through the weekend. He was evaluated by his physician on Tuesday and it was thought "it was just a regular virus". Later on Tuesday, the patient complained of being in the "worse pain of his life", he appeared swollen and had "bruise-like blotches" on his body. The patient was taken to the hospital and then transferred to another hospital. He was diagnosed with N-Meningitis serogroup unknown. Relevant diagnostic tests/laboratory data was reported as positive. Treatments were not reported. No further information was available at the time of the report. The patient''s outcome was fatal. The cause of death was reported as bacterial meningitis on 06 April 2011 (also reported as 05 April 2011). Documents held by sender: none.

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