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This is VAERS ID 241090

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241090
VAERS Form:
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1657AA / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: RASH MAC PAP

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccina"tion, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 12/8/2009

VAERS ID: 241090 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1657AA / - LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Rash macular, RASH MAC PAP

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccina"tion, vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 4/7/2010

VAERS ID: 241090 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1657AA / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 7/14/2014

VAERS ID: 241090 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1657AA / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 9/14/2017

VAERS ID: 241090 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / - UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 2/14/2018

VAERS ID: 241090 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 6/14/2018

VAERS ID: 241090 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 8/14/2018

VAERS ID: 241090 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 9/14/2018

VAERS ID: 241090 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.


Changed on 10/14/2018

VAERS ID: 241090 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-01
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash macular

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:
Preexisting Conditions: The pt''s past medical history is significant for anaphylaxis following an insect bite and she carries an EpiPen. The pt had no illnesses at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2005012530

Write-up: From initial info received on 6/29/05 from a physician, regarding an adverse event occurring in the USA, it was reported that a 17 year old female pt received a dose of Menactra, lot U1657AA, IM in the left arm at 14:00 on 6/29/05. 90 minutes post vaccination, the pt developed red, blotchy patches over her elbows and knees. She was seen by a physician and treated with Benadryl 50mg per os. The pt recovered from this event.

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