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This is VAERS ID 239856

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

Case Details

VAERS ID: 239856 (history)  
Form: Version .0  
Age: 18.0  
Sex: Female  
Location: Kansas  
Vaccinated:2005-06-13
Onset:2005-06-13
   Days after vaccination:0
Submitted: 2005-06-14
   Days after onset:1
Entered: 2005-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0635P / - RA / SC
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1589AA / - GM / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: DIZZINESS, DYSPNEA, PRURITUS, URTICARIA
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: Ortho-Tri-Cyclen
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12:45 pm MMR & Menactra vaccine given. 1:15 pm Pt. c/o itching and hives all over, difficulty breathing, feeling faint. 911 called. 1:20 pm Epinephrine 1:1000 1mg/ml 0.3cc SQ LUO Arm. 1:25 Con''''t difficutly breathingm, hives, itching, Epi 0.3 cc SQ R UOAr"m. 1:30 pm Paramedics arrived, pt transported to hospital.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=239856


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