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This is VAERS ID 236926

Case Details

VAERS ID: 236926 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2005-04-25
Onset:2005-04-26
   Days after vaccination:1
Submitted: 2005-04-28
   Days after onset:2
Entered: 2005-05-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1221BA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Recurrent hives. Started 04/26/05- seen in office for hives 04/28/05. RX for Claritin and predinisone taper.


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