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This is VAERS ID 239974

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 239974
VAERS Form:
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1639AA / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: VOMIT, RASH, HEADACHE, ASTHENIA, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 12/8/2009

VAERS ID: 239974 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1639AA / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting, VOMIT, RASH, HEADACHE, ASTHENIA, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 4/7/2010

VAERS ID: 239974 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1639AA / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 5/14/2017

VAERS ID: 239974 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1639AA / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 9/14/2017

VAERS ID: 239974 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 0 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 2/14/2018

VAERS ID: 239974 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 6/14/2018

VAERS ID: 239974 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 8/14/2018

VAERS ID: 239974 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 9/14/2018

VAERS ID: 239974 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.


Changed on 10/14/2018

VAERS ID: 239974 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Texas
Vaccinated:2005-06-15
Onset:2005-06-15
Submitted:2005-06-16
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1639AA / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting

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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Allergies:
Diagnostic Lab Data: NOT APPLICABLE
CDC 'Split Type':

Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=239974&WAYBACKHISTORY=ON


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