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From the 12/8/2009 release of VAERS data (an older release, current is 7/16/2021):

This is VAERS ID 233765



Case Details

VAERS ID: 233765 (history)  
Form: Version .0  
Age: 15.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2004-09-07
Onset:2004-10-15
   Days after vaccination:38
Submitted: 2005-02-08
   Days after onset:116
Entered: 2005-02-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR 307AA / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Crohn's disease, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal premalignant disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data: CT scan/Colonoscopy consistent with Crohn''s diagnosis.
CDC Split Type:

Write-up: Patient developed Crohn''s Disease about 10/15/04. Started with diarrhea, vomiting, and abdominal pain. Treatment has been Imovan, Prednisone, and Flagyl.


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