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This is VAERS ID 241188

Case Details

VAERS ID: 241188 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2005-07-07
Onset:2005-07-08
   Days after vaccination:1
Submitted: 2005-07-11
   Days after onset:3
Entered: 2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Fatigue, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 7/8, client noted "rash at base of neck increasing in intensity on left shoulder" with small 1/4" diameter raised areas. Denies rapid heartbeat or respiratory symptoms, itching. On 7/11 rash less intense, client has been "very tired, sleeping an extra 2-3 hours per day. Mother reported event to Health Dept and physician''s office.


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