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This is VAERS ID 239856

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 239856 (history)  
Form: Version 1.0  
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 / UNK RA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK GM / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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: 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 UOArm. 1:30 pm Paramedics arrived, pt transported to hospital.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=239856


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