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This is VAERS ID 663496

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2016

VAERS ID: 663496
VAERS Form:
Age:12.0
Gender:Male
Location:Vermont
Vaccinated:2016-10-18
Onset:2016-10-19
Submitted:2016-10-20
Entered:2016-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5410AA / - LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS LZ972 / - LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Erythema, Pruritus, Swelling, Tenderness

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 x 14 cm erythema, swelling. Tender centrally, itchy. Advised to give BENADRYL.


Changed on 9/14/2017

VAERS ID: 663496 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Male
Location:Vermont
Vaccinated:2016-10-18
Onset:2016-10-19
Submitted:2016-10-20
Entered:2016-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5410AA / - UNK LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS LZ972 / - UNK LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Erythema, Pruritus, Swelling, Tenderness

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 x 14 cm erythema, swelling. Tender centrally, itchy. Advised to give BENADRYL.


Changed on 2/14/2018

VAERS ID: 663496 Before After
VAERS Form:1
Age:12.0
Gender:Male
Location:Vermont
Vaccinated:2016-10-18
Onset:2016-10-19
Submitted:2016-10-20
Entered:2016-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5410AA / UNK LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS LZ972 / UNK LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Erythema, Pruritus, Swelling, Tenderness

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 x 14 cm erythema, swelling. Tender centrally, itchy. Advised to give BENADRYL.


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http://medalerts.org/vaersdb/findfield.php?IDNUMBER=663496&WAYBACKHISTORY=ON


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