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This is VAERS ID 240013

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 240013
VAERS Form:
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1656AC / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, HEADACHE, MYALGIA

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 12/8/2009

VAERS ID: 240013 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1656AC / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Headache, Myalgia, Pyrexia, FEVER, HEADACHE, MYALGIA

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 4/7/2010

VAERS ID: 240013 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1656AC / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 5/14/2017

VAERS ID: 240013 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1656AC / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 9/14/2017

VAERS ID: 240013 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 2/14/2018

VAERS ID: 240013 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 6/14/2018

VAERS ID: 240013 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 8/14/2018

VAERS ID: 240013 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 9/14/2018

VAERS ID: 240013 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.


Changed on 10/14/2018

VAERS ID: 240013 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Florida
Vaccinated:2005-06-10
Onset:2005-06-11
Submitted:2005-06-13
Entered:2005-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1656AC / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Received vaccine 9 AM 6/10/05. 6/11/05, developed fever 101-102, severe myalgias, headache. Responded to Tylenol over 24-36 hours. Known adverse effect but was severe.

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