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This is VAERS ID 236925

Case Details

VAERS ID: 236925 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2005-04-25
Onset:2005-04-25
   Days after vaccination:0
Submitted: 2005-04-29
   Days after onset:4
Entered: 2005-05-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR C11494AB / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Headache, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diflucan 4/25/05
Current Illness: vaginal discharge
Preexisting Conditions: allergy to amoxicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HA, Skin feels like crawling, tingling on exam, very faint, lacy rash on trunk. Temp 97.8. RX: Zyrtec.


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