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This is VAERS ID 241158

Case Details

VAERS ID: 241158 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2005-06-26
Onset:2005-06-26
   Days after vaccination:0
Submitted: 2005-06-29
   Days after onset:3
Entered: 2005-07-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt was seen for pain over R lower ribs but was afebrile and well; normal exam and no pain. Menactra was given around 09:54 AM on 9/26/05. Around 2 hrs later she came in complaining of headache (heavy head), chills and fever of 103.8. She was given Tylenol and observed. Fever went up to 104-105 and ibuprofen was given about 1 1/2 hrs later and she was discharged soon after.


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