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This is VAERS ID 417625

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2011

VAERS ID: 417625
VAERS Form:
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 UN / IJ
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UN / IJ
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UN / IJ

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 4/13/2011

VAERS ID: 417625 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 UN / IJ
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UN / IJ
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UN / IJ

Administered by: Military      Purchased by: Military
Symptoms: Activated partial thromboplastin time prolonged, Anion gap increased, Blood bicarbonate decreased, Blood calcium decreased, Blood creatinine increased, Blood fibrinogen decreased, Blood gases abnormal, Blood lactate dehydrogenase increased, Blood potassium increased, Blood urea increased, Bronchopneumonia, Cardiac arrest, Cardiac pacemaker insertion, Chest X-ray abnormal, Computerised tomogram normal, CSF culture positive, CSF glucose normal, CSF lymphocyte count abnormal, CSF pressure increased, CSF protein normal, Death, Depressed level of consciousness, Disseminated intravascular coagulation, Fatigue, Headache, Intensive care, Lumbar puncture, Meningitis meningococcal, Meningococcal infection, Metabolic acidosis, Nausea, Neutrophil count increased, Pain, Petechiae, Platelet count decreased, Prothrombin time prolonged, Purpura fulminans, Respiratory failure, Resuscitation, Septic shock, Thrombocytopenia, Blood phosphorus increased, Haemodynamic instability, Lymphocyte percentage decreased, CSF neutrophil count increased, CSF white blood cell count increased, Computerised tomogram head, CSF test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 5/13/2011

VAERS ID: 417625 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 UN / IJ
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UN / IJ
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UN / IJ

Administered by: Military      Purchased by: Military
Symptoms: Activated partial thromboplastin time prolonged, Anion gap increased, Blood bicarbonate decreased, Blood calcium decreased, Blood creatinine increased, Blood fibrinogen decreased, Blood gases abnormal, Blood lactate dehydrogenase increased, Blood potassium increased, Blood urea increased, Bronchopneumonia, Cardiac arrest, Cardiac pacemaker insertion, Chest X-ray abnormal, Computerised tomogram normal, CSF culture positive, CSF glucose normal, CSF lymphocyte count abnormal, CSF pressure increased, CSF protein normal, Death, Depressed level of consciousness, Disseminated intravascular coagulation, Fatigue, Headache, Intensive care, Lumbar puncture, Meningitis meningococcal, Meningococcal infection, Metabolic acidosis, Nausea, Neutrophil count increased, Pain, Petechiae, Platelet count decreased, Prothrombin time prolonged, Purpura fulminans, Respiratory failure, Resuscitation, Septic shock, Thrombocytopenia, Blood phosphorus increased, Haemodynamic instability, Lymphocyte percentage decreased, CSF neutrophil count increased, CSF white blood cell count increased, Computerised tomogram head, CSF test abnormal, Endotracheal intubation, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 7/13/2012

VAERS ID: 417625 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 UN / IJ -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UN / IJ -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UN / IJ -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 6/14/2014

VAERS ID: 417625 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 4/14/2017

VAERS ID: 417625 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 9/14/2017

VAERS ID: 417625 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 2 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / - UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / - UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 2/14/2018

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 6/14/2018

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 8/14/2018

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 9/14/2018

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 10/14/2018

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 12/24/2020

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 12/30/2020

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 5/7/2021

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.


Changed on 5/14/2021

VAERS ID: 417625 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:South Carolina
Vaccinated:2010-12-03
Onset:2011-02-04
Submitted:2011-02-25
Entered:2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB207AC / 3 UN / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER E0204 / UNK UN / -
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR U786AA / UNK UN / -

Administered by: Military      Purchased by: Military
Symptoms: Death, Meningococcal infection, CSF test abnormal, Neisseria test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-05
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: Menactra Made by Sanofi Pasteur. Pt started antibiotics after vaccination but before death.
Current Illness: All recruits screened by Recruit Medical Readiness (RMR) staff. No evidence of illness during screening.
Preexisting Conditions: No known illness.
Allergies:
Diagnostic Lab Data: CSF tested by SC medical centers resulted as N. meningitidis. Serotype Y.
CDC 'Split Type':

Write-up: No known adverse event at tim eof the vaccination. Pt died on 02/05/2011.

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