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This is VAERS ID 241626

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 241626
VAERS Form:
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, U1589AA / - RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE 52B003AA / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTONIA, CONVULS, FEVER, HYPERTONIA

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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 12/8/2009

VAERS ID: 241626 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, AVENTIS PASTEUR U1589AA / - RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS 52B003AA / - LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, Hypertonia, Hypotonia, Pyrexia, HYPOTONIA, CONVULS, FEVER, HYPERTONIA

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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 4/7/2010

VAERS ID: 241626 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1589AA / - RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 5/14/2017

VAERS ID: 241626 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1589AA / - RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 9/14/2017

VAERS ID: 241626 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / - UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / - UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 2/14/2018

VAERS ID: 241626 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 6/14/2018

VAERS ID: 241626 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 8/14/2018

VAERS ID: 241626 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 9/14/2018

VAERS ID: 241626 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.


Changed on 10/14/2018

VAERS ID: 241626 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Oregon
Vaccinated:2005-07-08
Onset:2005-07-15
Submitted:2005-07-20
Entered:2005-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1589AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 52B003AA / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Hypertonia, Hypotonia, 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: Seotrads, Amoxicillin
Current Illness: Breast Infection
Preexisting Conditions: ADHD, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: One week after immunizations patient had a brief (3 minutes) generalized tonic-clonic seizure. Had low grade fever for several days prior to that. History of one previous seizure last year.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=241626&WAYBACKHISTORY=ON


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