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This is VAERS ID 526852

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2014

VAERS ID: 526852
VAERS Form:
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 6/14/2014

VAERS ID: 526852 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 3/14/2015

VAERS ID: 526852 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 9/14/2017

VAERS ID: 526852 Before After
VAERS Form:(blank) 1
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 2/14/2018

VAERS ID: 526852 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 6/14/2018

VAERS ID: 526852 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 8/14/2018

VAERS ID: 526852 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 9/14/2018

VAERS ID: 526852 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.


Changed on 10/14/2018

VAERS ID: 526852 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Foreign
Vaccinated:2013-10-30
Onset:2014-03-04
Submitted:2014-03-26
Entered:2014-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture throat, Death, Intensive care, Meningitis meningococcal, Upper respiratory tract infection, Bacterial test negative, Streptococcus test negative, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-04
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Con Meds =Unknown; Prev Meds =Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. Based on the information received from the laboratory supervisor; the blood culture remained negative for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The laboratory supervisor verbally confirmed the test result but he refused to provide the results in written.
CDC 'Split Type': 2014SA034156

Write-up: Initial case was received from a health care professional via Sales representative on 17 March 2014. A 13-months-old female patient whose medical history and concomitant medication was not reported had received MENACTRA (dose, route and anatomical site of administration not reported) on 30 October 2013. On 25 February 2014, the patient was admitted to the hospital. The patient started treatment with suspected upper respiratory tract infection after the throat culture (the result of throat culture was not reported). On 26 February 2014, she was admitted to the private hospital and was transferred to Hospital with suspected meningococcal meningitis for the reason that the patient had an eruption. The patient was closely monitored by the reporting physician in the pediatric intensive care unit. The blood was closely monitored by the reporting physician in the pediatric intensive care unit. The blood and cerebrospinal fluid samples were collected from the patient. However the reporter physician could not provide the results of test. The patient died on 04 March 2014. Comment: This case could not be considered as the lack of efficacy. Because, MENACTRA is indicated in children aged from 12 months to 15 years as two doses (three months apart) according to our local labeling information. However, MENACTRA was administered to the patient as a single dose. The list of documents held by sender: None.

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