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This is VAERS ID 241626

Case Details

VAERS ID: 241626 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Oregon  
Vaccinated:2005-07-08
Onset:2005-07-15
   Days after vaccination:7
Submitted: 2005-07-20
   Days after onset:5
Entered: 2005-07-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


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