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This is VAERS ID 241086

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241086
VAERS Form:
Age:59.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE AHAVB043BA / - - / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1492 / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: VASODILAT, MED ERROR

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered o"n 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days


Changed on 12/8/2009

VAERS ID: 241086 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) HEP A (HAVRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / - - / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1492 / 0 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Flushing, Medication error, VASODILAT, MED ERROR

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered o"n on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event.


Changed on 1/5/2010

VAERS ID: 241086 Before After
VAERS Form:
Age:59.0 58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / - - / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1492 / 0 - / -

Administered by: Private      Purchased by: Other Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 4/7/2010

VAERS ID: 241086 Before After
VAERS Form:
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / - - / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 6/14/2014

VAERS ID: 241086 Before After
VAERS Form:
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / - - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 5/14/2017

VAERS ID: 241086 Before After
VAERS Form:
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / - - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 9/14/2017

VAERS ID: 241086 Before After
VAERS Form:(blank) 1
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / - UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 0 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 2/14/2018

VAERS ID: 241086 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 6/14/2018

VAERS ID: 241086 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 8/14/2018

VAERS ID: 241086 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 9/14/2018

VAERS ID: 241086 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.


Changed on 10/14/2018

VAERS ID: 241086 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:D.C.
Vaccinated:2005-06-02
Onset:2005-06-03
Submitted:2005-06-27
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB043BA / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1492 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Flushing, Medication error

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: Celebrex, Flexeril, Prilosec
Current Illness:
Preexisting Conditions: The pt has an allergy to Ceftin derivatives. He had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200501081

Write-up: From initial info received on 6/7/05 from a health care professional regarding an adverse event occurring in the USA, it was reported that a 58 year old male pt received a dose of Menactra, lot U1492AB and a dose of Havrix, lot AHAVB0543BA, administered on 6/2/05. The routes and sites of administration were unknown as per the reporter. The following day, on 6/3/05, the pt developed redness on his face, entire arms and legs. There was no itching and no fever reported. The duration of the redness was 2 days and the symptoms then disappeared. The pt recovered from the event. Follow up report received on Sept 6, 2005 from a health care professional. It is reported that no previous doses of Havrix was given prior to the June 2m, 2005 injection. No laboratory testing was done. Information was reviewed by the responsible physician and no addiitonal information can be provided at this time. No further information is expected.

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