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This is VAERS ID 241509

Case Details

VAERS ID: 241509 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2005-06-10
Onset:2005-06-25
   Days after vaccination:15
Submitted: 2005-07-18
   Days after onset:23
Entered: 2005-07-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Dysarthria, Guillain-Barre syndrome, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tubersol
Current Illness:
Preexisting Conditions: The patient has no significant past medical history and did not have any illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200501360

Write-up: Initial report received from a health care professional on 7/14/05. An 18 year old male patient received an IM left deltoid injection of Menactra, lot number U1494AB, and an ID right forearm injection of Tubersol 5 TU., lot number C2116AA, on 6/10/05. 15 days later he experienced intermittent tingling in his feet. He was seen by a physician on 6/26/05 and was admitted to the hospital to rule out Guillain-Barre Syndrome. He was released from the hospital on 6/29/05, but was re-admitted on 7/1/05 with facial weakness and slurred speech. He was diagnosed with Guillain-Barre Syndrome. The patient received treatment with plasmaphoresis and was discharged on 7/8/05. As per the reporter, the patient''s recovery status is unknown.


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