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This is VAERS ID 483916

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 483916
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


Changed on 9/14/2017

VAERS ID: 483916 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


Changed on 2/14/2018

VAERS ID: 483916 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


Changed on 6/14/2018

VAERS ID: 483916 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


Changed on 8/14/2018

VAERS ID: 483916 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


Changed on 9/14/2018

VAERS ID: 483916 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.


Changed on 10/14/2018

VAERS ID: 483916 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:0000-00-00
Onset:2013-02-01
Submitted:2013-02-06
Entered:2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Malaise, Meningitis bacterial

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-03
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201301601

Write-up: Initial report was received from a healthcare professional on 04 February 2013. A 19-year-old female patient had received an injection of MENINGOCOCCAL VACCINE (manufacturer, lot number, route, site and date of administration not reported) and an unspecified amount of time later became ill and was hospitalized on 01 February 2013. The patient was diagnosed with bacterial meningitis. The patient died on 03 February 2013. No additional information was provided. Outcome was fatal. Documents held by sender: None.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=483916&WAYBACKHISTORY=ON


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