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This is VAERS ID 240008

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 240008
VAERS Form:
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U149AB / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: SYNCOPE

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 12/8/2009

VAERS ID: 240008 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U149AB / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness, SYNCOPE

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 4/7/2010

VAERS ID: 240008 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U149AB / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 5/14/2017

VAERS ID: 240008 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U149AB / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 9/14/2017

VAERS ID: 240008 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U149AB / 0 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 2/14/2018

VAERS ID: 240008 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U149AB / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 6/14/2018

VAERS ID: 240008 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U149AB / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 8/14/2018

VAERS ID: 240008 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U149AB / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 9/14/2018

VAERS ID: 240008 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U149AB / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.


Changed on 10/14/2018

VAERS ID: 240008 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Maryland
Vaccinated:2005-06-10
Onset:2005-06-10
Submitted:2005-06-10
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U149AB / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness

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: NONE
Current Illness: NONE
Preexisting Conditions: High fever with pertussis as infant; no other problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 5 minutes after Menactra 0.5ml IM given, client lost consciousness. Epinephrine 0.5mg SQ given. Client regained consciousness and was transported to ER for medical evaluation.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=240008&WAYBACKHISTORY=ON


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