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This is VAERS ID 239876

Case Details

VAERS ID: 239876 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Alabama  
Vaccinated:2005-06-08
Onset:2005-06-08
   Days after vaccination:0
Submitted: 2005-06-09
   Days after onset:1
Entered: 2005-06-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 01493AC / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Body temperature increased, Dysarthria, Dyspnoea, Malaise, Muscle twitching
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: PPD- Aventis C2114AB LFA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR, CBC, CMP, UA- results not reported
CDC Split Type:

Write-up: Mom states pt came home at 7:00 from date not feeling well. Temp 100 F. Took ibuprofen. At 10:00 began to mumble and moan. c/o SOB. Then started twitching all over- 911 called. Pt taken to nearest hospital. Pt given IV fluids- Tordal and Ativan.


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