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This is VAERS ID 241090

Case Details

VAERS ID: 241090 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2005-06-29
Onset:2005-06-29
   Days after vaccination:0
Submitted: 2005-07-01
   Days after onset:2
Entered: 2005-07-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash macular
SMQs:, Hypersensitivity (narrow), 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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


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