National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 582853

History of Changes from the VAERS Wayback Machine

First Appeared on 7/14/2015

VAERS ID: 582853
VAERS Form:
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? No
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: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 4/14/2016

VAERS ID: 582853 Before After
VAERS Form:
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2016-04-12
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: (blank) 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 9/14/2017

VAERS ID: 582853 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 1 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2016-04-12
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: 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 2/14/2018

VAERS ID: 582853 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2016-04-12
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: 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 6/14/2018

VAERS ID: 582853 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2016-04-12
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: 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 8/14/2018

VAERS ID: 582853 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2016-04-12
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: 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 9/14/2018

VAERS ID: 582853 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2016-04-12
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: 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.


Changed on 10/14/2018

VAERS ID: 582853 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Arizona
Vaccinated:2015-06-08
Onset:2015-06-10
Submitted:2015-06-23
Entered:2015-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR A14097 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Adenoidal hypertrophy, Computerised tomogram abnormal, Intensive care, Mononucleosis heterophile test positive, Pharyngeal oedema, Tonsillar hypertrophy, Mechanical ventilation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2016-04-12
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: 301     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin; Steroid
Current Illness: Tonsillitis
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: (+) Mono test at urgent care 6/10/15; (+) tonsil/adenoid/throat swelling on CT 6/13/15
CDC 'Split Type':

Write-up: Pt. was mildly ill with tonsillitis when vaccine given. 2 days later went to urgent care for worsening (throat swelling). 2 days later went to hospital ED for throat swelling and transported to another hospital. In PICU now x 3 days on ventilator. They think severe EBV infection, but unsure.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=582853&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166