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This is VAERS ID 238948

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 238948 (history)  
Form: Version .0  
Age: 11.0  
Sex: Male  
Location: Michigan  
Vaccinated:2005-05-21
Onset:2005-05-21
   Days after vaccination:0
Submitted: 2005-05-23
   Days after onset:2
Entered: 2005-06-02
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1494AB / 0 RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, U1186AA / 0 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: FEVER, HYSN INJECT SITE, PAIN, VASODILAT
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2/" red, warm area rig"ht bicep; tender to palp.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=238948


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