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This is VAERS ID 240005

Case Details

VAERS ID: 240005 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2005-05-18
Onset:2005-05-19
   Days after vaccination:1
Submitted: 2005-05-20
   Days after onset:1
Entered: 2005-06-17
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1526AC / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Headache, Neck pain, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 05/20/2005 Mom called - reported 05/19/2005, headache started at 3PM. Neck hurts, aching, not feeling well in general. Abdominal pain. Symptoms relieved by Tylenol, eating Okay, no nausea/vomiting. Did not take temperature.


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