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This is VAERS ID 719567

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2018

VAERS ID: 719567
VAERS Form:2
Age:
Sex:Unknown
Location:Foreign
Vaccinated:2017-01-12
Onset:2017-09-01
Submitted:0000-00-00
Entered:2017-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Death, Meningococcal infection, Vaccination failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2017-09-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': RUSA2017SA191699

Write-up: Initial unsolicited report received from a physician on 02-Oct-2017. This case involves a 33-month old patient (age reported as 2.8 years) (gender unknown), who was vaccinated with MENACTRA (batch number, expiry date, dose, route and site of administration was not reported) on 12-Jan-2017. The patient''s ongoing illness / medical history / risk factors were unknown and concomitant medications were not reported. On an unknown date of Sep-2017, few months after the vaccination, patient experienced meningococcaemia serotype C under provisional exclusion according to blood test result, and death happened during 24 hours (date of date also reported as Sep-2017). It was also a case of vaccination failure. Other lab test and corrective treatment was unknown. It was unknown whether autopsy was performed or not. The physician associated death with vaccination failure. Documents held by sender: none.; Sender''s Comments: This case concerns a 2-year-old child who reportedly experienced serogroup C meningococcal infection with a fatal outcome approximately 8 months after receiving MENACTRA vaccine. Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. Relevant information including but not limited to vaccination details (lot number, route, site and actual date of vaccination), vaccination history, patient''s demographics (gender and date of birth), clinical details, the diagnostic tests performed, and the patient''s medical history and immune status (B cell immunity, mannose binding lectin [MBL] and complement status, ...) is lacking to allow adequate medical assessment.; Reported Cause(s) of Death: Meningococcaemia.


Changed on 6/14/2018

VAERS ID: 719567 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Foreign
Vaccinated:2017-01-12
Onset:2017-09-01
Submitted:0000-00-00
Entered:2017-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Death, Meningococcal infection, Vaccination failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2017-09-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': RUSA2017SA191699

Write-up: Initial unsolicited report received from a physician on 02-Oct-2017. This case involves a 33-month old patient (age reported as 2.8 years) (gender unknown), who was vaccinated with MENACTRA (batch number, expiry date, dose, route and site of administration was not reported) on 12-Jan-2017. The patient''s ongoing illness / medical history / risk factors were unknown and concomitant medications were not reported. On an unknown date of Sep-2017, few months after the vaccination, patient experienced meningococcaemia serotype C under provisional exclusion according to blood test result, and death happened during 24 hours (date of date also reported as Sep-2017). It was also a case of vaccination failure. Other lab test and corrective treatment was unknown. It was unknown whether autopsy was performed or not. The physician associated death with vaccination failure. Documents held by sender: none.; Sender''s Comments: This case concerns a 2-year-old child who reportedly experienced serogroup C meningococcal infection with a fatal outcome approximately 8 months after receiving MENACTRA vaccine. Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. Relevant information including but not limited to vaccination details (lot number, route, site and actual date of vaccination), vaccination history, patient''s demographics (gender and date of birth), clinical details, the diagnostic tests performed, and the patient''s medical history and immune status (B cell immunity, mannose binding lectin [MBL] and complement status, ...) is lacking to allow adequate medical assessment.; Reported Cause(s) of Death: Meningococcaemia.


Changed on 8/14/2018

VAERS ID: 719567 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Foreign
Vaccinated:2017-01-12
Onset:2017-09-01
Submitted:0000-00-00
Entered:2017-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Death, Meningococcal infection, Vaccination failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2017-09-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': RUSA2017SA191699

Write-up: Initial unsolicited report received from a physician on 02-Oct-2017. This case involves a 33-month old patient (age reported as 2.8 years) (gender unknown), who was vaccinated with MENACTRA (batch number, expiry date, dose, route and site of administration was not reported) on 12-Jan-2017. The patient''s ongoing illness / medical history / risk factors were unknown and concomitant medications were not reported. On an unknown date of Sep-2017, few months after the vaccination, patient experienced meningococcaemia serotype C under provisional exclusion according to blood test result, and death happened during 24 hours (date of date also reported as Sep-2017). It was also a case of vaccination failure. Other lab test and corrective treatment was unknown. It was unknown whether autopsy was performed or not. The physician associated death with vaccination failure. Documents held by sender: none.; Sender''s Comments: This case concerns a 2-year-old child who reportedly experienced serogroup C meningococcal infection with a fatal outcome approximately 8 months after receiving MENACTRA vaccine. Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. Relevant information including but not limited to vaccination details (lot number, route, site and actual date of vaccination), vaccination history, patient''s demographics (gender and date of birth), clinical details, the diagnostic tests performed, and the patient''s medical history and immune status (B cell immunity, mannose binding lectin [MBL] and complement status, ...) is lacking to allow adequate medical assessment.; Reported Cause(s) of Death: Meningococcaemia.


Changed on 9/14/2018

VAERS ID: 719567 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Foreign
Vaccinated:2017-01-12
Onset:2017-09-01
Submitted:0000-00-00
Entered:2017-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Death, Meningococcal infection, Vaccination failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2017-09-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': RUSA2017SA191699

Write-up: Initial unsolicited report received from a physician on 02-Oct-2017. This case involves a 33-month old patient (age reported as 2.8 years) (gender unknown), who was vaccinated with MENACTRA (batch number, expiry date, dose, route and site of administration was not reported) on 12-Jan-2017. The patient''s ongoing illness / medical history / risk factors were unknown and concomitant medications were not reported. On an unknown date of Sep-2017, few months after the vaccination, patient experienced meningococcaemia serotype C under provisional exclusion according to blood test result, and death happened during 24 hours (date of date also reported as Sep-2017). It was also a case of vaccination failure. Other lab test and corrective treatment was unknown. It was unknown whether autopsy was performed or not. The physician associated death with vaccination failure. Documents held by sender: none.; Sender''s Comments: This case concerns a 2-year-old child who reportedly experienced serogroup C meningococcal infection with a fatal outcome approximately 8 months after receiving MENACTRA vaccine. Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. Relevant information including but not limited to vaccination details (lot number, route, site and actual date of vaccination), vaccination history, patient''s demographics (gender and date of birth), clinical details, the diagnostic tests performed, and the patient''s medical history and immune status (B cell immunity, mannose binding lectin [MBL] and complement status, ...) is lacking to allow adequate medical assessment.; Reported Cause(s) of Death: Meningococcaemia.


Changed on 10/14/2018

VAERS ID: 719567 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Foreign
Vaccinated:2017-01-12
Onset:2017-09-01
Submitted:0000-00-00
Entered:2017-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Death, Meningococcal infection, Vaccination failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2017-09-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': RUSA2017SA191699

Write-up: Initial unsolicited report received from a physician on 02-Oct-2017. This case involves a 33-month old patient (age reported as 2.8 years) (gender unknown), who was vaccinated with MENACTRA (batch number, expiry date, dose, route and site of administration was not reported) on 12-Jan-2017. The patient''s ongoing illness / medical history / risk factors were unknown and concomitant medications were not reported. On an unknown date of Sep-2017, few months after the vaccination, patient experienced meningococcaemia serotype C under provisional exclusion according to blood test result, and death happened during 24 hours (date of date also reported as Sep-2017). It was also a case of vaccination failure. Other lab test and corrective treatment was unknown. It was unknown whether autopsy was performed or not. The physician associated death with vaccination failure. Documents held by sender: none.; Sender''s Comments: This case concerns a 2-year-old child who reportedly experienced serogroup C meningococcal infection with a fatal outcome approximately 8 months after receiving MENACTRA vaccine. Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. Relevant information including but not limited to vaccination details (lot number, route, site and actual date of vaccination), vaccination history, patient''s demographics (gender and date of birth), clinical details, the diagnostic tests performed, and the patient''s medical history and immune status (B cell immunity, mannose binding lectin [MBL] and complement status, ...) is lacking to allow adequate medical assessment.; Reported Cause(s) of Death: Meningococcaemia.

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