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This is VAERS ID 663496

Case Details

VAERS ID: 663496 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Vermont  
Vaccinated:2016-10-18
Onset:2016-10-19
   Days after vaccination:1
Submitted: 2016-10-20
   Days after onset:1
Entered: 2016-10-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5410AA / UNK LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS LZ972 / UNK LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Pruritus, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 x 14 cm erythema, swelling. Tender centrally, itchy. Advised to give BENADRYL.


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