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This is VAERS ID 241136

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241136
VAERS Form:
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1494AB / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: NAUSEA, HEADACHE, ASTHENIA, DIARRHEA, PARESTHESIA

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 day"s. Father called health department 7/08/2005 to report this event. States son is still very fatigued and /"not himself/".


Changed on 12/8/2009

VAERS ID: 241136 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1494AB / 0 LA / IM

Administered by: Public      Purchased by: Unknown Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour, NAUSEA, HEADACHE, ASTHENIA, DIARRHEA, PARESTHESIA

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 day"s. days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and /"not himself/". "not himself". Information from medical records state myasthenia.


Changed on 4/7/2010

VAERS ID: 241136 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1494AB / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 5/14/2017

VAERS ID: 241136 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1494AB / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 9/14/2017

VAERS ID: 241136 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 0 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 2/14/2018

VAERS ID: 241136 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 6/14/2018

VAERS ID: 241136 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 8/14/2018

VAERS ID: 241136 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 9/14/2018

VAERS ID: 241136 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.


Changed on 10/14/2018

VAERS ID: 241136 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Michigan
Vaccinated:2005-06-23
Onset:2005-06-26
Submitted:2005-07-08
Entered:2005-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1494AB / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Myasthenic syndrome, Nausea, Vomiting, White blood cell count increased, CSF test abnormal, Abnormal behaviour

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Information received from medical records states white count increased, lab tests abnormal, cerebral spinal fluid abnormal.
CDC 'Split Type':

Write-up: Father states pt c/o headache, nausea and vomiting, and diarrhea 6/26/2005. Father states headache persisted but nausea, vomiting, and diarrhea stopped 7/04/2005 and then on 7/04/2005 left arm and entire left side of body went numb. Hospitalized for 3 days. Father called health department 7/08/2005 to report this event. States son is still very fatigued and "not himself". Information from medical records state myasthenia.

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