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This is VAERS ID 241087

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241087
VAERS Form:
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 1 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1573AC / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: LYMPHADENO, MYALGIA, LYMPHEDEMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/0"5. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician.


Changed on 12/8/2009

VAERS ID: 241087 Before After
VAERS Form:
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 1 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1573AC / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Lymphadenopathy, Lymphoedema, Myalgia, LYMPHADENO, MYALGIA, LYMPHEDEMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/0"5. 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 1/5/2010

VAERS ID: 241087 Before After
VAERS Form:
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 1 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1573AC / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy, Lymphoedema, Myalgia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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:
Current Illness: NONE
Preexisting Conditions: NONE The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 4/7/2010

VAERS ID: 241087 Before After
VAERS Form:
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 1 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy, Lymphoedema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 7/31/2010

VAERS ID: 241087 Before After
VAERS Form:
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 9/14/2017

VAERS ID: 241087 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 1 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 2/14/2018

VAERS ID: 241087 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 6/14/2018

VAERS ID: 241087 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 8/14/2018

VAERS ID: 241087 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 9/14/2018

VAERS ID: 241087 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.


Changed on 10/14/2018

VAERS ID: 241087 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2005-06-06
Onset:2005-06-07
Submitted:2005-06-15
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB010AB / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1573AC / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chest X-ray normal, Erythema, Full blood count normal, Lymph node pain, Lymphadenopathy, Lymphoedema, Myalgia, Red blood cell sedimentation rate increased, Ultrasound scan abnormal

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:
Current Illness: NONE
Preexisting Conditions: The patient denied any significant past medical history or illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: CXR negative; Sono of chest-worse-lymphedema only; CBC nl; ESR=18mm/hr
CDC 'Split Type': 200501114

Write-up: From initial info received on 6/9/05 from an RN regarding an adverse occurring in the USA, it was reported that a 16 year old male pt received his 1st dose of Menactra, lot U1573AC, IM, RA, as well as his 2nd dose of Hep-A, lot AHAVB010AB, IM, LA on 6/6/05. The following day, on 6/7/05, the pt developed an enlarged lymph node with profuse redness and tenderness in the axillary area, which spread across his latissimus dorsal muscle and extended to the chest and nipple area. The pt was seen by a physician. It was not reported whether the pt recovered from these events.

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