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This is VAERS ID 241609

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241609
VAERS Form:
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1677AA / 0 RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) / MASS. PUB HLTH B TD-120 / 5 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: CHILLS, FEVER, NAUSEA, HYSN INJECT SITE, HEADACHE

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, a"t same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 12/8/2009

VAERS ID: 241609 Before After
VAERS Form:
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1677AA / 0 RA / IM
TD: TD ADSORBED, ADULT (NO BRAND NAME) TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH B MASS. PUB HLTH BIOL LAB TD-120 / 5 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia, CHILLS, FEVER, NAUSEA, HYSN INJECT SITE, HEADACHE

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, a"t at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 4/7/2010

VAERS ID: 241609 Before After
VAERS Form:
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1677AA / 0 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 5 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 5/14/2017

VAERS ID: 241609 Before After
VAERS Form:
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1677AA / 0 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 5 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 9/14/2017

VAERS ID: 241609 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 0 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 5 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 2/14/2018

VAERS ID: 241609 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 6/14/2018

VAERS ID: 241609 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 8/14/2018

VAERS ID: 241609 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 9/14/2018

VAERS ID: 241609 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 10/14/2018

VAERS ID: 241609 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.


Changed on 4/14/2019

VAERS ID: 241609 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2005-07-18
Onset:2005-07-19
Submitted:2005-07-21
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1677AA / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) TD ADSORBED (TDVAX) / MASS. PUB HLTH BIOL LAB TD-120 / 6 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Headache, Injection site erythema, Nausea, Pyrexia

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: Please note in question #13.the No of previous doses of tetanus component (5)included the DTP and DTap vaccines received as part of childhood immunizations.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received Menactra IM right arm approximately 1:00 PM on 7/18/2005. Woke at 4:00 AM 7/19/05 with fever chills, headache and slight nausea. Fever relieved by Tylenol but returned as it wore off. Slight redness @ site. Received Td at left deltoid also, at same visit. Upon return call to client on 7/20/05, signs and symptoms resolved.

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