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This is VAERS ID 241514

Case Details

VAERS ID: 241514 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2005-07-11
Onset:2005-07-12
   Days after vaccination:1
Submitted: 2005-07-19
   Days after onset:7
Entered: 2005-07-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), 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: NONE
CDC Split Type:

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


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