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This is VAERS ID 241130

Case Details

VAERS ID: 241130 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2005-07-08
Onset:2005-07-08
   Days after vaccination:0
Submitted: 2005-07-08
   Days after onset:0
Entered: 2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial and truncal urticaria, no signs of anaphylactic shock or asthma, within 1 hour of administration of vaccine.


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