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This is VAERS ID 241584

Case Details

VAERS ID: 241584 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: Illinois  
Vaccinated:2005-07-16
Onset:2005-07-16
   Days after vaccination:0
Submitted: 2005-07-18
   Days after onset:2
Entered: 2005-07-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1684AA / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Malaise, Photosensitivity reaction, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Dr had called health dept to report that pt had low grade fever (100.9); feeling of malaise, faint rash, urticaria, photosensitivity.


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