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This is VAERS ID 241222

Case Details

VAERS ID: 241222 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Virginia  
Vaccinated:2005-06-29
Onset:2005-06-30
   Days after vaccination:1
Submitted: 2005-07-07
   Days after onset:7
Entered: 2005-07-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1575AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110P / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: PPD, Aventis, C2677AA, ID, LA, 0 previously; Augmentin
Current Illness: Furuncle
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Local swelling, redness and itching on left upper arm. Was improving when seen in office on 7/1/05.


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