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This is VAERS ID 241087

Case Details

VAERS ID: 241087 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2005-06-06
Onset:2005-06-07
   Days after vaccination:1
Submitted: 2005-06-15
   Days after onset:8
Entered: 2005-07-08
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC Split Type: 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


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