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This is VAERS ID 239998

Case Details

VAERS ID: 239998 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2005-06-15
Onset:2005-06-15
   Days after vaccination:0
Submitted: 2005-06-17
   Days after onset:2
Entered: 2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0490P / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Oedema, Rash erythematous, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: NONE
Preexisting Conditions: Hodgkins Lymphoma; Asthma; Allergic rhinitis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left deltoid local reaction. Erythema, induration 8cmx6cm, edema, tenderness, warmth at site. Erythematous rash around site. No other urticaria, fever, or pruritus. No arthralgia.


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