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This is VAERS ID 239982

Case Details

VAERS ID: 239982 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2005-06-14
Onset:2005-06-14
   Days after vaccination:0
Submitted: 2005-06-16
   Days after onset:2
Entered: 2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB074AA / 1 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVA021AA / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1525AAB / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1210AA / 3 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR Y0794 / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Lexapro, Androderm, Multivitamin
Current Illness: currently having loose stools
Preexisting Conditions: Chronic Abdominal Discomfort/Irritable Bowel Syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that he developed headaches, low grade fever of 99 degrees and general malaise.


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