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This is VAERS ID 240004

Case Details

VAERS ID: 240004 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2005-06-13
Onset:2005-06-13
   Days after vaccination:0
Submitted: 2005-06-15
   Days after onset:2
Entered: 2005-06-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


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