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This is VAERS ID 241156

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241156
VAERS Form:
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1657AA / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: PAIN INJECT SITE, HYSN INJECT SITE, MALAISE

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 12/8/2009

VAERS ID: 241156 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1657AA / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site erythema, Injection site pain, Malaise, PAIN INJECT SITE, HYSN INJECT SITE, MALAISE

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 4/7/2010

VAERS ID: 241156 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1657AA / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 5/14/2017

VAERS ID: 241156 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1657AA / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 9/14/2017

VAERS ID: 241156 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 2/14/2018

VAERS ID: 241156 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 6/14/2018

VAERS ID: 241156 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 8/14/2018

VAERS ID: 241156 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 9/14/2018

VAERS ID: 241156 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.


Changed on 10/14/2018

VAERS ID: 241156 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New York
Vaccinated:2005-06-29
Onset:2005-06-29
Submitted:2005-07-07
Entered:2005-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1657AA / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise

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

Write-up: Malaise, soreness at injection site and redness x 2 d.

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