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This is VAERS ID 483916

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 483916 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted: 2013-02-06
   Days after onset:5
Entered: 2013-02-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-02-03
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=483916


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