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This is VAERS ID 240013

Case Details

VAERS ID: 240013 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2005-06-10
Onset:2005-06-11
   Days after vaccination:1
Submitted: 2005-06-13
   Days after onset:2
Entered: 2005-06-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


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