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This is VAERS ID 238948

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 238948 (history)  
Form: Version 1.0  
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 CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, Pyrexia, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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 right bicep; tender to palp.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=238948


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