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This is VAERS ID 241514

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241514
VAERS Form:
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE 0002R / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1641AA / 0 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: DIZZINESS, FEVER, MASS INJECT SITE, HYSN INJECT SITE, HEADACHE

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 12/8/2009

VAERS ID: 241514 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) HEP A (HAVRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS 0002R / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1641AA / 0 RA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia, DIZZINESS, FEVER, MASS INJECT SITE, HYSN INJECT SITE, HEADACHE

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 4/7/2010

VAERS ID: 241514 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1641AA / 0 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 5/14/2017

VAERS ID: 241514 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 0 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1641AA / 0 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 9/14/2017

VAERS ID: 241514 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 0 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 0 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 2/14/2018

VAERS ID: 241514 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 6/14/2018

VAERS ID: 241514 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 8/14/2018

VAERS ID: 241514 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 9/14/2018

VAERS ID: 241514 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.


Changed on 10/14/2018

VAERS ID: 241514 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:California
Vaccinated:2005-07-11
Onset:2005-07-12
Submitted:2005-07-19
Entered:2005-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0002R / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1641AA / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site induration, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Localized erythema and induration R deltoid. Dizziness, fever, HA within 24 hours of admin. Treated wth Benadryl, Motrin and rest.

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