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This is VAERS ID 241088

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241088
VAERS Form:
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1640AA / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: RASH, URTICARIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly,"2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''''s recovery status wa


Changed on 12/8/2009

VAERS ID: 241088 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1640AA / 0 LA / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Rash, Urticaria, RASH, URTICARIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly,"2 Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''''s pt''s recovery status wa was reported as not recovered.


Changed on 4/7/2010

VAERS ID: 241088 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1640AA / 0 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 5/14/2017

VAERS ID: 241088 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1640AA / 0 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 9/14/2017

VAERS ID: 241088 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 0 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 2/14/2018

VAERS ID: 241088 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 6/14/2018

VAERS ID: 241088 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 8/14/2018

VAERS ID: 241088 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 9/14/2018

VAERS ID: 241088 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.


Changed on 10/14/2018

VAERS ID: 241088 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:South Carolina
Vaccinated:2005-06-13
Onset:2005-06-15
Submitted:2005-06-28
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1640AA / 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Albuterol
Current Illness:
Preexisting Conditions: The pt has a past medical history of asthma and is allergic to Cefadyl. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005011830

Write-up: From initial info received on 6/17/05 from an RN regarding an adverse event occurring in the USA, it was reported that an 11 year old male pt received his 1st dose of Menactra vaccine, lot U1640AA, administered in the left deltoid on 6/13/05. Reportedly, 2 days later, on 6/15/05, the pt developed a rash on his face and hands. Two days later, on 6/17/05, the rash progressed to welts on his torso. He had no complaints of fever or itching. The symptoms were treated with Benadryl. The pt''s recovery status was reported as not recovered.

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