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This is VAERS ID 237147

Case Details

VAERS ID: 237147 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2005-04-27
Onset:2005-04-27
   Days after vaccination:0
Submitted: 2005-04-28
   Days after onset:1
Entered: 2005-05-09
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / UNK RA / -

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


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