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This is VAERS ID 241513

Case Details

VAERS ID: 241513 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2005-07-07
Onset:2005-07-08
   Days after vaccination:1
Submitted: 2005-07-11
   Days after onset:3
Entered: 2005-07-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / UNK RA / -

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


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