National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 241089

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241089
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1659AA / 0 RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PURPURA

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type':

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5"TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physic


Changed on 12/8/2009

VAERS ID: 241089 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) HEP A (VAQTA) / MERCK & CO. INC. M1090D / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1659AA / 0 RA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Purpura, PURPURA

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': (blank) 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5"TU, 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physic physician. It is unknown at this time whether the pt recovered from this event.


Changed on 4/7/2010

VAERS ID: 241089 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1659AA / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 5/14/2017

VAERS ID: 241089 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1659AA / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 9/14/2017

VAERS ID: 241089 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 0 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 0 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 2/14/2018

VAERS ID: 241089 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 6/14/2018

VAERS ID: 241089 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 8/14/2018

VAERS ID: 241089 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 9/14/2018

VAERS ID: 241089 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.


Changed on 10/14/2018

VAERS ID: 241089 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2005-06-17
Onset:2005-06-28
Submitted:0000-00-00
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M1090D / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1659AA / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Purpura

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: Tubersol 5 TU, lot C207AA, ID, left forearm
Current Illness:
Preexisting Conditions: The pt has no significant past medical history and did not have any significant illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data: Laboratory data obtained included a urinalysis, CBC, BUN, creatine and electrolytes. No results were provided at this time.
CDC 'Split Type': 2005012500

Write-up: From initial info received on 6/28/05 from a physician regarding an adverse event occurring in the USA, it was reported that an 18 year old male pt received his 1st dose of Menactra, lot U1659AA, administered IM in the right deltoid, a dose of Tubersol 5 TU, lot C207AA, administered ID in the left forearm and a dose of hepatitis A vaccine, lot M1090D, administered in the left deltoid on 6/17/05. Eleven days later, on the morning of 6/28/05, the pt developed generalized purpura. The pt was seen by a physician. It is unknown at this time whether the pt recovered from this event.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=241089&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166