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This is VAERS ID 403759

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 403759
VAERS Form:
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / - RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / - RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / - LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / - LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 1/4/2011

VAERS ID: 403759 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / - RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / - RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / - LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / - LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0 (blank)     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 6/14/2014

VAERS ID: 403759 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / - RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / - RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / - LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / - LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 4/14/2017

VAERS ID: 403759 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / - RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / - RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / - LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / - LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 9/14/2017

VAERS ID: 403759 Before After
VAERS Form:(blank) 1
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / - UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / - UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / - UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / - UNK LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 2/14/2018

VAERS ID: 403759 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / UNK LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 6/14/2018

VAERS ID: 403759 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / UNK LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 8/14/2018

VAERS ID: 403759 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / UNK LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 9/14/2018

VAERS ID: 403759 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / UNK LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.


Changed on 10/14/2018

VAERS ID: 403759 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:New Jersey
Vaccinated:2010-09-09
Onset:2010-09-17
Submitted:2010-10-15
Entered:2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0568Z / UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UA3058AA / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3476AA / UNK LA / UN

Administered by: Unknown      Purchased by: Private
Symptoms: Asthenia, Death, Malaise

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-09-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Mother called me on 9-17-10 afternoon that her son is sick and feeling very weak. I recommended the mother to take him to nearest ER as the patient was about 50 miles away and mother took him to ER where he was transferred to another hospital.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=403759&WAYBACKHISTORY=ON


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