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This is VAERS ID 239974

Case Details

VAERS ID: 239974 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2005-06-15
Onset:2005-06-15
   Days after vaccination:0
Submitted: 2005-06-16
   Days after onset:1
Entered: 2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC Split Type:

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


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