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This is VAERS ID 241513

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241513
VAERS Form:
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / - RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1641AA / - LA / -
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, U1209DA / - RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: EDEMA INJECT SITE, PAIN INJECT SITE, HYSN INJECT SITE, MOVEMENT DIS

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 12/8/2009

VAERS ID: 241513 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) HEP A (VAQTA) / MERCK & CO. INC. 1093P / - RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1641AA / - LA / -
TD: TD ADSORBED, ADULT (NO BRAND NAME) TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR, AVENTIS PASTEUR U1209DA / - RA / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder, EDEMA INJECT SITE, PAIN INJECT SITE, HYSN INJECT SITE, MOVEMENT DIS

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 4/7/2010

VAERS ID: 241513 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / - RA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1641AA / - LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / - RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 5/14/2017

VAERS ID: 241513 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / - RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1641AA / - LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / - RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 9/14/2017

VAERS ID: 241513 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / - UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / - UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / - UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 2/14/2018

VAERS ID: 241513 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 6/14/2018

VAERS ID: 241513 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 8/14/2018

VAERS ID: 241513 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 9/14/2018

VAERS ID: 241513 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.


Changed on 10/14/2018

VAERS ID: 241513 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2005-07-07
Onset:2005-07-08
Submitted:2005-07-11
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1093P / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / UNK LA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1209DA / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Movement disorder

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pt with erythema, edema, pain RUE with paresthesia and temporary immobility in all 20 phalanges. Tx: Motrin, Warm compresses.

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