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This is VAERS ID 236739

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 236739
VAERS Form:
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1493AC / - RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, 41221DA / 5 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, PAIN BACK, PAIN, PAIN NECK

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 120 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 12/8/2009

VAERS ID: 236739 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1493AC / - RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR, AVENTIS PASTEUR 41221DA / 5 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia, FEVER, PAIN BACK, PAIN, PAIN NECK

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 120 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 4/7/2010

VAERS ID: 236739 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1493AC / - RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 5 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 5/14/2017

VAERS ID: 236739 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1493AC / - RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 5 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 9/14/2017

VAERS ID: 236739 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / - UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 5 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 2/14/2018

VAERS ID: 236739 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 6/14/2018

VAERS ID: 236739 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 8/14/2018

VAERS ID: 236739 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 9/14/2018

VAERS ID: 236739 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.


Changed on 10/14/2018

VAERS ID: 236739 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Maryland
Vaccinated:2005-04-25
Onset:2005-04-26
Submitted:2005-04-28
Entered:2005-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1493AC / UNK RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 41221DA / 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Back pain, Neck pain, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: tics
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Temp max 102 degrees. Neck and back pain. Soreness of whole arm- Arm where Td was received.

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