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This is VAERS ID 238948

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 238948
VAERS Form:
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1494AB / 0 RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, U1186AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, HYSN INJECT SITE, PAIN, VASODILAT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2/" red, warm area rig"ht bicep; tender to palp.


Changed on 12/8/2009

VAERS ID: 238948 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1494AB / 0 RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR, AVENTIS PASTEUR U1186AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site erythema, Injection site warmth, Pyrexia, Tenderness, FEVER, HYSN INJECT SITE, PAIN, VASODILAT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2/" 2" red, warm area rig"ht right bicep; tender to palp.


Changed on 4/7/2010

VAERS ID: 238948 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1494AB / 0 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 2/14/2017

VAERS ID: 238948 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1494AB / 0 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 9/14/2017

VAERS ID: 238948 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 0 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 2/14/2018

VAERS ID: 238948 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 6/14/2018

VAERS ID: 238948 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 8/14/2018

VAERS ID: 238948 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 9/14/2018

VAERS ID: 238948 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.


Changed on 10/14/2018

VAERS ID: 238948 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Michigan
Vaccinated:2005-05-21
Onset:2005-05-21
Submitted:2005-05-23
Entered:2005-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 RA / IM
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1186AA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness: Asthma; Allergies
Preexisting Conditions: ADD; Asthma; Allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child presented for 11 year PE on 5/21/05. Menactra administered IM right deltoid. Td administered IM left deltoid. Onset fever Saturday PM; increased to 103.6 oral. No other symptoms. Patient seen in office on 5/23/05. Exam NL with 2" red, warm area right bicep; tender to palp.

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