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This is VAERS ID 469573

Case Details

VAERS ID: 469573 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: New York  
   Days after vaccination:3
Submitted: 2012-10-11
   Days after onset:73
Entered: 2012-10-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Autopsy, Death, Hypersomnia, Posture abnormal, Resuscitation, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: The patient was autistic and had a past medical history of seizures. He had no illness at the time of vaccination.
Diagnostic Lab Data: An autopsy was performed on an unspecified date. No results were provided.
CDC Split Type: 201209473

Write-up: Initial information received on 10 October 2012 from a patient''s parent. An 18-year-old male patient received a dose of MENACTRA (lot number U4256AA) intramuscularly in the arm on 27 July 2012. The patient was autistic and had a history of seizures. Concomitant medications included DEPAKOTE, KEPPRA, and KLONOPIN as needed for seizures. The patient had no illness at the time of vaccination. The patient''s parent reported that her son was very sleepy on 29 July 2012 and slept all day. He went to summer session at regular time the following day, 30 July 2012, and returned home at regular time at 12:30 pm. He went into his room and played computer games. At 3:30 pm the patient was found with his head slumped on his computer. Cardiopulmonary resuscitation (CPR) was initiated and emergency services (911) was called. The patient was transferred to the hospital and CPR continued for 45 minutes before the patient was pronounced dead. An autopsy was completed, but no results were provided at the time of this report. Documents held by sender: none.

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