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This is VAERS ID 241088

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 241088 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2005-06-13
Onset:2005-06-15
   Days after vaccination:2
Submitted: 2005-06-28
   Days after onset:13
Entered: 2005-07-08
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=241088


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