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This is VAERS ID 801161

Case Details

VAERS ID: 801161 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2019-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Death, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-02-02
   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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: ZASA2019SA033666

Write-up: Patient passed away; rash; Initial information received on 04-Feb-2019 regarding an unsolicited valid serious case received from a nurse. This case involves a 20 months old male patient who had rash and passed away while he received vaccine MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE [MENACTRA]. The patient''s past medical history and concomitant medication was not reported. On 01-Feb-2019, the patient received a dose of suspect MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE (lot number, expiry date, dose, dose in series, route and site of administration was not reported). On 02-Feb-2019, one day after the vaccination the patient experienced serious rash and at night passed away. Rash was assessed as medically significant and other event was leading to death. (Other relevant tests included no lab data.) Final diagnosis was rash and (fatal) patient passed away. It was not reported if the patient received a corrective treatment. The event outcome was reported as Fatal on 02-Feb-2019 for patient passed away and as Unknown for rash. It was unknown if an autopsy was done. The cause of death was not reported. List of documents held by sender: none.; Sender''s Comments: This is a case involves a 20 months male who experienced rash one day after vaccination with Menactra and passed away in the night. Patient''s medical history and concomitant medication were not reported. There is no information regarding patient''s medical condition at time of vaccination and previous vaccination history, as well as no investigation results ruling out alternative etiologies. The autopsy report was not provided. Adequate information is not available in this report for a complete medical assessment.; Reported Cause(s) of Death: Death nos

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