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This is VAERS ID 588222

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2015

VAERS ID: 588222
VAERS Form:
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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.


Changed on 9/14/2017

VAERS ID: 588222 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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.


Changed on 2/14/2018

VAERS ID: 588222 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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.


Changed on 6/14/2018

VAERS ID: 588222 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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.


Changed on 8/14/2018

VAERS ID: 588222 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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.


Changed on 9/14/2018

VAERS ID: 588222 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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.


Changed on 10/14/2018

VAERS ID: 588222 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2004-07-09
Onset:2004-07-11
Submitted:2015-07-31
Entered:2015-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2004-07-11
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? 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?IDNUMBER=588222&WAYBACKHISTORY=ON


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