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This is VAERS ID 237147

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 237147
VAERS Form:
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1494AB / - LA / -
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, 4121107 / - RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: EDEMA INJECT SITE, HYSN INJECT SITE, DYSPNEA

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 12/8/2009

VAERS ID: 237147 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1494AB / - LA / -
TD: TD ADSORBED, ADULT (NO BRAND NAME) TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR, AVENTIS PASTEUR 4121107 / - RA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema, EDEMA INJECT SITE, HYSN INJECT SITE, DYSPNEA

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 4/7/2010

VAERS ID: 237147 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1494AB / - LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / - RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 5/14/2017

VAERS ID: 237147 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1494AB / - LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / - RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 9/14/2017

VAERS ID: 237147 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / - UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / - UNK RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 2/14/2018

VAERS ID: 237147 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / UNK RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 6/14/2018

VAERS ID: 237147 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / UNK RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 8/14/2018

VAERS ID: 237147 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / UNK RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 9/14/2018

VAERS ID: 237147 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / UNK RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids


Changed on 10/14/2018

VAERS ID: 237147 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Virginia
Vaccinated:2005-04-27
Onset:2005-04-27
Submitted:2005-04-28
Entered:2005-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR 4121107 / UNK RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Injection site erythema, Injection site oedema

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

Write-up: Swelling and redness at injection site, shortness of breath, treated in ER with nebulizer and steroids

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=237147&WAYBACKHISTORY=ON


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