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This is VAERS ID 241086

Case Details

VAERS ID: 241086 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: D.C.  
Vaccinated:2005-06-02
Onset:2005-06-03
   Days after vaccination:1
Submitted: 2005-06-27
   Days after onset:24
Entered: 2005-07-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Flushing, Medication error
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Medication errors (narrow)

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


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