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This is VAERS ID 235879

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 235879
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1494AB / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, NAUSEA, HYSN INJECT SITE, MYALGIA, MALAISE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned,"states much improved. Only symptom tenderness around injection site.


Changed on 12/8/2009

VAERS ID: 235879 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1494AB / 0 LA / IM

Administered by: Other      Purchased by: Unknown Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness, FEVER, NAUSEA, HYSN INJECT SITE, MYALGIA, MALAISE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned,"states phoned, states much improved. Only symptom tenderness around injection site.


Changed on 4/7/2010

VAERS ID: 235879 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1494AB / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 5/14/2017

VAERS ID: 235879 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1494AB / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 9/14/2017

VAERS ID: 235879 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 0 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 2/14/2018

VAERS ID: 235879 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 6/14/2018

VAERS ID: 235879 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 8/14/2018

VAERS ID: 235879 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 9/14/2018

VAERS ID: 235879 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.


Changed on 10/14/2018

VAERS ID: 235879 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Michigan
Vaccinated:2005-03-29
Onset:2005-03-29
Submitted:2005-03-30
Entered:2005-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Menactra 0.5cc administered at 11:30AM. Pt states approx 2 hrs later began to feel ill. Injection site sore. 3/30/05 c/o temp 99.6, nauseated, body aches, injection site sore and red, pt instr. to use ice on site and ibuprofen or Tylenol. 3/31 pt phoned, states much improved. Only symptom tenderness around injection site.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=235879&WAYBACKHISTORY=ON


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