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This is VAERS ID 241156

Case Details

VAERS ID: 241156 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2005-06-29
Onset:2005-06-29
   Days after vaccination:0
Submitted: 2005-07-07
   Days after onset:8
Entered: 2005-07-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to penicillin.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Malaise, soreness at injection site and redness x 2 d.


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