National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 496656

History of Changes from the VAERS Wayback Machine

First Appeared on 8/12/2013

VAERS ID: 496656
VAERS Form:
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 1 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 0 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 5 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


Changed on 9/17/2013

VAERS ID: 496656 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 1 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 0 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 5 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Angioedema, Blood sodium increased, Chest discomfort, Dysphagia, Dyspnoea, Hypersensitivity, Local swelling, Pallor, Protein total increased, Swelling face, Throat tightness, Neutrophil percentage increased, Lymphocyte percentage decreased, Sensation of foreign body

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy The following information was obtained through follow-up and/or provided by the government. 8/6/13. ER records. PMH: asthma; bicuspid aortic valve; developmental delay; ALL, s/p chemotherapy. Vancomycin; amytriptilline.
Allergies:
Diagnostic Lab Data: None The following information was obtained through follow-up and/or provided by the government. 8/6/13. ER records. WBC 9.8 K/mm3 (N), neuts 86% (H), lymphs 12% (L). Na 147 mmol/L (H), T protein 9.6 g/dL (H).
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot. The following information was obtained through follow-up and/or provided by the government. 8/6/13. ER records DOS 7/12-13/2013. DX: allergic rxn; angioedema. CC: difficulty breathing; lump in throat; swelling face et neck; pallor; swallowing difficulty. Admitted overnight. Condition improved c epinephrine, steroids et bronchodilator. DC in stable condition to f/u c PCP et allergist.


Changed on 3/14/2015

VAERS ID: 496656 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 1 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 0 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 5 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Angioedema, Blood sodium increased, Chest discomfort, Dysphagia, Dyspnoea, Hypersensitivity, Local swelling, Pallor, Protein total increased, Swelling face, Throat tightness, Neutrophil percentage increased, Lymphocyte percentage decreased, Sensation of foreign body

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy The following information was obtained through follow-up and/or provided by the government. 8/6/13. ER records. PMH: asthma; bicuspid aortic valve; developmental delay; ALL, s/p chemotherapy. Vancomycin; amytriptilline.
Allergies:
Diagnostic Lab Data: None The following information was obtained through follow-up and/or provided by the government. 8/6/13. ER records. WBC 9.8 K/mm3 (N), neuts 86% (H), lymphs 12% (L). Na 147 mmol/L (H), T protein 9.6 g/dL (H).
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot. The following information was obtained through follow-up and/or provided by the government. 8/6/13. ER records DOS 7/12-13/2013. DX: allergic rxn; angioedema. CC: difficulty breathing; lump in throat; swelling face et neck; pallor; swallowing difficulty. Admitted overnight. Condition improved c epinephrine, steroids et bronchodilator. DC in stable condition to f/u c PCP et allergist.


Changed on 9/14/2017

VAERS ID: 496656 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 1 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 0 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 0 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 5 6 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


Changed on 2/14/2018

VAERS ID: 496656 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 6 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


Changed on 6/14/2018

VAERS ID: 496656 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 6 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


Changed on 8/14/2018

VAERS ID: 496656 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 6 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


Changed on 9/14/2018

VAERS ID: 496656 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 6 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


Changed on 10/14/2018

VAERS ID: 496656 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2013-07-12
Onset:2013-07-12
Submitted:2013-07-12
Entered:2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 6 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=496656&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166