Already in VAERS on 12/31/2003 |
| VAERS ID: |
72429
|
Vaccinated: |
1994-04-11 |
| Age: |
47.9 |
Onset: |
1994-04-11 |
| Gender: |
Male |
Submitted: |
1994-12-09 |
| Location: |
Minnesota |
Entered: |
1995-03-30 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: had magnified local rxn to TET TOX & typhoid vaxs; |
| Other Medications: |
| Current Illness: |
| Preexisting Conditions: |
| Diagnostic Lab Data: |
| CDC 'Split Type': |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| MEN: MENOMUNE A/C/Y/W |
CONNAUGHT LABS |
4C61080 |
|
|
|
|
| Administered by: Private
Purchased by: Unknown |
| Symptoms: CHILLS, TREMOR, MYALGIA, PALLOR, PARESTHESIA |
| Write-up: pt recvd vax;severe chills,tremors,vasoconstriction;Reynaud''s phenomenon w/ white fingers & numbness;absent radial pulses,stiff neck;started 1/2 hr p/vax;had 2 days of mild chills,myalgias;resolved w/IV fluids,dph over 1/2 hr; |
|
|
Changed on 12/8/2009 |
| VAERS ID: |
72429 Before
After
|
Vaccinated: |
1994-04-11 |
| Age: |
47.9 |
Onset: |
1994-04-11 |
| Gender: |
Male |
Submitted: |
1994-12-09 |
| Location: |
Minnesota |
Entered: |
1995-03-30/1995-02-14 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: had magnified local rxn to TET TOX & typhoid vaxs; |
| Other Medications: |
| Current Illness: |
| Preexisting Conditions: |
| Diagnostic Lab Data: |
CDC 'Split Type':
(blank)
CO5388 |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| MEN: MENOMUNE A/C/Y/W/MENINGOCOCCAL (MENOMUNE) |
CONNAUGHT LABS/CONNAUGHT LABORATORIES |
4C61080 |
|
|
|
|
| Administered by: Private
Purchased by: Unknown/Other |
| Symptoms: Chills, Myalgia, Pallor, Paraesthesia, Peripheral vascular disorder, Tremor, Vasospasm, CHILLS, TREMOR, MYALGIA, PALLOR, PARESTHESIA |
| Write-up: pt recvd vax;severe chills,tremors,vasoconstriction;Reynaud''s phenomenon w/ white fingers & numbness;absent radial pulses,stiff neck;started 1/2 hr p/vax;had 2 days of mild chills,myalgias;resolved w/IV fluids,dph over 1/2 hr; |
|
|
