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This is VAERS ID 241609

Case Details

VAERS ID: 241609 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
Vaccinated:2005-07-18
Onset:2005-07-19
   Days after vaccination:1
Submitted: 2005-07-21
   Days after onset:2
Entered: 2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (TDVAX) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


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