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This is VAERS ID 241585

Case Details

VAERS ID: 241585 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
Vaccinated:2005-07-08
Onset:2005-07-09
   Days after vaccination:1
Submitted: 2005-07-15
   Days after onset:6
Entered: 2005-07-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER U1563BA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog
Current Illness:
Preexisting Conditions: Diabetic type I, seizure last 1999, no treatment since 2002.
Allergies:
Diagnostic Lab Data: Seen by neurologist in ER, EEG normal.
CDC Split Type:

Write-up: Seizure on 7/9/05 transported to ER, seen by neurologist, EEG done.


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