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This is VAERS ID 241089

Case Details

VAERS ID: 241089 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2005-06-17
Onset:2005-06-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC Split Type: 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


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