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From the 5/7/2021 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 1.0  
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) / SANOFI PASTEUR 307AA / 1 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), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune disorders (narrow)

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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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=233765


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