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This is VAERS ID 241157

Case Details

VAERS ID: 241157 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2005-06-28
Onset:2005-06-30
   Days after vaccination:2
Submitted: 2005-07-01
   Days after onset:1
Entered: 2005-07-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / SC
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1221BA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Neck pain, Shoulder pain
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: PPD, Aventis, C2077AA, LA, 0 previously
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: TD and MMR given 6/28/05 in L deltoid. Swelling developed between L shoulder and neck area on 6/30/05. Slight pain upon palpation of area. No fever. No redness.


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