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This is VAERS ID 540483

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

Case Details

VAERS ID: 540483 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2014-08-19
Entered: 2014-08-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Blindness, Brain death, Convulsion, Death, Gastrostomy, Posture abnormal, Ventriculo-peritoneal shunt
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Lab tests unknown
CDC Split Type: 2014SA110867

Write-up: Initial report received from a consumer, who is also the patient''s mother, on 14 August 2014. The following is verbatim from the report: "I lost my son at year and a half. But after 10 months. After he got the meningitis enoculation. He became brain dead blind dead outward posturing constant seizes. Gastrostomy tube and a shunt in his brain. Shot was what killed him. Panhandlers health." No further information was available at the time of the report. The patient outcome was fatal. Documents held by sender: None.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=540483


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