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This is VAERS ID 539223

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 539223 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2014-07-28
Onset:2014-07-28
   Days after vaccination:0
Submitted: 2014-08-07
   Days after onset:10
Entered: 2014-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4798AA / 1 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4837AB / 1 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Cardiac failure, Lethargy, Myocarditis, Pyrexia, Troponin T increased, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2014-08-25
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported.
Preexisting Conditions: None elicited.
Allergies:
Diagnostic Lab Data: 8/3/2014 08:00 Troponin T: 10.090 (H)
CDC Split Type:

Write-up: Fever, lethargy. Later developed vomiting and went into heart failure. Preliminary diagnosis of Acute myocarditis.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=539223


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