Report #2852436

Received Aug 3, 2025

ER / ED visitOffice visit

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 12 yrs
State: WV
Recovered: Unknown
Vaccinated: Nov 27, 2024
Onset: Nov 30, 2024
Days to onset: 3
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
MNQ	MENINGOCOCCAL CONJUGATE (MENACTRA)	SANOFI PASTEUR	UNK	3443E	IM / RA
TDAP	TDAP (ADACEL)	SANOFI PASTEUR	UNK	U8339BA	IM / LA

Symptoms (11)

CyanosisDyskinesiaEchocardiogramElectrocardiogramElectrocardiogram ambulatoryElectrocardiogram normalElectroencephalogramGenetic testingImaging procedureLaboratory testUnresponsive to stimuli

Symptom narrative

Event occurred on the evening of 11/30/2024 around 8:50pm. My son was sitting on the couch, almost asleep when I looked at him and noticed his arms were moving away from his body in a slow motion and his lips began to turn blue. I immediately called 911 and after calling I noticed my son had stopped with the arms movements. But his entire body looked lifeless and he was unresponsive . He was not breathing and had turned completely blue. He was rushed to our local hospital. When we arrived at the hospital he was taken immediately back to the trauma area and was laid on the exam table. He finally became responsive again, this was shortly after 9pm.

Current illness

N/A

Medical history

Allergic Rhinitis

Other medications

N/A

Allergies

NKDA

Lab data

11/30/2025 - laboratory testing, radiology testing, and EKG testing; 12/31/2024 - EEG; 01/13/2025 - Genetic testing; 01/24/2025 - Cardiac testing: ECG, Echo, Extended Holter monitor