Received Jun 5, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| UNK | VACCINE NOT SPECIFIED (OTHER) | UNKNOWN MANUFACTURER | UNK | — | SYR / LA |
Meningococcal vaccine - Dr mentioned its the one required for college entry. Side effects 1 day after vaccine included: Low fever, vomited one time today (reported same day as symptoms occurred), hot and cold flashes, slight rash, can't swallow, hands shaking, vision goes faint, body aches. Patient is 16 years old and had prior hospitalization from MMR + chickenpox vaccine when she was 2. Patient was not sick prior to getting vaccine and was healthy.
Completely healthy prior to vaccination and one month prior.
High functioning autism which started after MMR vaccines reaction and hospitalization which was reported when she was 2 years old. MMR vaccine reaction and hospitalization at age 2 was reported in this system. Doctors continue to continue regular vaccine schedules despite problem at age 2.
Adderal generic brand for ADHD
Tree nut allergy (walnuts,etc)
TBD. REported as of 6/4 (one day after vaccination as soon as symptoms first appeared). Hoping we don't have to go to the hospital. I'm assuming I can update this form if we have to go to the hospital tomorrow or she doesn't get better. Need to be able to report as it happens and update the system based on daily findings and provide daily updates.
MMR + ChickenPox at Age 2. Hospitalized and likely resulted in Autism. I have saved records and photos from the hospital visit