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This is VAERS ID 291020

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

291020
VAERS Form:
Age:14.0
Gender:Female
Location:Colorado
Vaccinated:2007-08-17
Onset:2007-08-17
Submitted:2007-09-04
Entered:2007-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / SC
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pain, Injection site pruritus

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: Calcium, Advil
Current Illness:
Preexisting Conditions: The patient had no pre-existing medical conditions/allergies and no illness at time of vaccination. Concomitant medications: Advil PRN; Calcium at times.
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Initial and non-serious report received from the patient''''s parent (a healthcare professional) on 20 August 2007. A 14-year-old female with no pre-existing medical conditions or allergies received subcutaneous injections of Menactra (lot number and site n"ot reported) and Varicella (manufacturer, Lot number and site not reported) on 17 August 2007 and that same day she experienced pain and redness at the injection site. The following day, the injection site was very swollen (9x6 inches), indurated, edemato


Changed on 12/8/2009

291020 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Colorado
Vaccinated:2007-08-17
Onset:2007-08-17
Submitted:2007-09-04
Entered:2007-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / SC
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pain, Injection site pruritus, Injection site swelling

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: Calcium, Advil
Current Illness:
Preexisting Conditions: The patient had no pre-existing medical conditions/allergies and no illness at time of vaccination. Concomitant medications: Advil PRN; Calcium at times.
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': (blank) 200702837

Write-up:Initial and non-serious report received from the patient''''s patient''s parent (a healthcare professional) on 20 August 2007. A 14-year-old female with no pre-existing medical conditions or allergies received subcutaneous injections of Menactra (lot number and site n"ot not reported) and Varicella (manufacturer, Lot number and site not reported) on 17 August 2007 and that same day she experienced pain and redness at the injection site. The following day, the injection site was very swollen (9x6 inches), indurated, edemato edematous and itchy, with no drainage. The patient was afebrile. It was reported that the patient was to see a doctor. Recovery status had been reported as "not recovered". The patient was previously vaccinated with Gardasil (manufactured by Merck); Lot number and route/site not reported) on 18 July 2007. No additional information had been provided at the time of this report.


Changed on 4/7/2010

291020 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Colorado
Vaccinated:2007-08-17
Onset:2007-08-17
Submitted:2007-09-04
Entered:2007-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / SC
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pain, Injection site pruritus, Injection site swelling

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: Calcium, Advil
Current Illness:
Preexisting Conditions: The patient had no pre-existing medical conditions/allergies and no illness at time of vaccination. Concomitant medications: Advil PRN; Calcium at times.
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': 200702837

Write-up:Initial and non-serious report received from the patient''s parent (a healthcare professional) on 20 August 2007. A 14-year-old female with no pre-existing medical conditions or allergies received subcutaneous injections of Menactra (lot number and site not reported) and Varicella (manufacturer, Lot number and site not reported) on 17 August 2007 and that same day she experienced pain and redness at the injection site. The following day, the injection site was very swollen (9x6 inches), indurated, edematous and itchy, with no drainage. The patient was afebrile. It was reported that the patient was to see a doctor. Recovery status had been reported as "not recovered". The patient was previously vaccinated with Gardasil (manufactured by Merck); Lot number and route/site not reported) on 18 July 2007. No additional information had been provided at the time of this report.


Changed on 9/14/2017

291020 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Colorado
Vaccinated:2007-08-17
Onset:2007-08-17
Submitted:2007-09-04
Entered:2007-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UNK UN / SC
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pain, Injection site pruritus, Injection site swelling

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: Calcium, Advil
Current Illness:
Preexisting Conditions: The patient had no pre-existing medical conditions/allergies and no illness at time of vaccination. Concomitant medications: Advil PRN; Calcium at times.
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': 200702837

Write-up:Initial and non-serious report received from the patient''s parent (a healthcare professional) on 20 August 2007. A 14-year-old female with no pre-existing medical conditions or allergies received subcutaneous injections of Menactra (lot number and site not reported) and Varicella (manufacturer, Lot number and site not reported) on 17 August 2007 and that same day she experienced pain and redness at the injection site. The following day, the injection site was very swollen (9x6 inches), indurated, edematous and itchy, with no drainage. The patient was afebrile. It was reported that the patient was to see a doctor. Recovery status had been reported as "not recovered". The patient was previously vaccinated with Gardasil (manufactured by Merck); Lot number and route/site not reported) on 18 July 2007. No additional information had been provided at the time of this report.


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