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This is VAERS ID 588222

(NOTE: This result is from the 8/14/2015 version of the VAERS database)

Case Details

VAERS ID: 588222 (history)  
Form: Version .0  
Age: 5.0  
Sex: Male  
Location: Unknown  
Vaccinated:2004-07-09
Onset:2004-07-11
   Days after vaccination:2
Submitted: 2015-07-31
   Days after onset:4037
Entered: 2015-08-03
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Meningoencephalitis viral
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2004-07-11
   Days after onset: 0
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: 2015SA111946

Write-up: Initial unsolicited report received from a consumer (patient''s parent) on 25 July 2015. A male child patient (age not reported), whose medical history and concomitant medications were not reported, had received a dose of Meningococcal vaccine (batch number, route of administration and site of administration were not reported) on an unspecified date. On an unspecified date, two days later the patient died of viral meningoencephalitis. Laboratory investigations and corrective treatments were not reported. Documents held by sender: none.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150814&IDNUMBER=588222


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