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This is VAERS ID 240004

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 240004
VAERS Form:
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1574AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: DIZZINESS, FEVER, NAUSEA, PAIN, ASTHENIA

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 12/8/2009

VAERS ID: 240004 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1574AA / - LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration, DIZZINESS, FEVER, NAUSEA, PAIN, ASTHENIA

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 4/7/2010

VAERS ID: 240004 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1574AA / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 5/14/2017

VAERS ID: 240004 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1574AA / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 9/14/2017

VAERS ID: 240004 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / - UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 2/14/2018

VAERS ID: 240004 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 6/14/2018

VAERS ID: 240004 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 8/14/2018

VAERS ID: 240004 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 9/14/2018

VAERS ID: 240004 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.


Changed on 10/14/2018

VAERS ID: 240004 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Indiana
Vaccinated:2005-06-13
Onset:2005-06-13
Submitted:2005-06-15
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1574AA / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration

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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.

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