|
| VAERS ID: |
597882 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Unknown |
| Location: |
Unknown |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
2015-08-13 |
| Entered: |
2015-09-21 |
| Days after submission: | 39 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Chills
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2015247002
Write-up: This is a spontaneous report from a contactable reporter (contactable consumer or other non HCP, Manager and immunization coordinator for the department of health) who reported for 4 patients via a sales representative. This is 2nd of the 4th report. A patient of unspecified age ethnicity and gender received TRUMENBA via an unspecified route of administration on an unspecified date. The patient experienced body chills on an unspecified date with outcome of unknown. |
|
| VAERS ID: |
597885 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Unknown |
| Location: |
Unknown |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
2015-08-13 |
| Entered: |
2015-09-21 |
| Days after submission: | 39 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / UNK |
UN / UN |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Injection site pain,
Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2015249966
Write-up: This is a spontaneous report from Pfizer sale representative who was reporting on behalf of non contactable physician for his patient. This is the third report of three reports. A patient of unspecified age ethnicity and gender received TRUMENBA, at single dose, MENACTRA and HUMAN PAPILLOMAVIRUS VACCINE, all via an unspecified route of administration on an unknown date. The patient medical history and concomitant medications were not reported. On an unspecified date, the patient experienced pain at the injection site and muscle pain that was radiated down to the hand. The outcome of the events was unknown. |
|
| VAERS ID: |
597888 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Unknown |
| Location: |
Unknown |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
2015-08-13 |
| Entered: |
2015-09-21 |
| Days after submission: | 39 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Chills,
Fatigue,
Headache
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2015249967
Write-up: This is a spontaneous report from Pfizer sales representative on behalf of an other healthcare professional (the receptionist who was calling on behalf of physician) for a patient. The is the second of three reports. A patient of an unspecified age, gender and ethnicity received TRUMENBA single dose, on an unknown date. Relevant medical history and concomitant medications were unknown. The patient experienced headache, fatigue, and chills on an unspecified date. Clinical outcome of the events was unknown. |
|
| VAERS ID: |
597896 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Unknown |
| Location: |
Unknown |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
2015-08-13 |
| Entered: |
2015-09-21 |
| Days after submission: | 39 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Chills,
Headache
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2015247003
Write-up: This is a spontaneous report from a contactable consumer via a sales representative. A patient of unspecified age, ethnicity and gender received a single dose of TRUMENBA via an unspecified route of administration on an unspecified date. Medical history and concomitant medications were not reported. The patient experienced chills and headache on an unspecified date (the day after the vaccination) with outcome of unknown. |
|
| VAERS ID: |
597630 (history) |
| Form: |
Version 1.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Virginia |
| Vaccinated: | 2015-05-15 |
| Onset: | 0000-00-00 |
| Submitted: |
2015-09-22 |
| Entered: |
2015-09-23 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
K026246 / 3 |
LA / IM |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29203 / 1 |
LA / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Nephrotic syndrome
SMQs:, Chronic kidney disease (broad), Proteinuria (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC Split Type:
Write-up: TRUMENBA administered 5/15/15 (will go to boarding school). Nephrotic syndrome diagnosed approximately 6/11/15-symptoms present for. |
|
| VAERS ID: |
597811 (history) |
| Form: |
Version 1.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2015-04-29 |
| Onset: | 2015-04-29 |
| Days after vaccination: | 0 |
| Submitted: |
2015-08-13 |
| Days after onset: | 106 |
| Entered: |
2015-09-29 |
| Days after submission: | 47 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / 1 |
LA / IM |
Administered by: Other Purchased by: Other
Symptoms: Injection site pain,
Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness:
Preexisting Conditions: 04/2015, Dyspepsia; Mechanical urticaria
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2015149889
Write-up: This is a spontaneous report obtained from a contactable consumer (lawyer who is the patient). This 25-year-old female patient received, on 29Apr2015, the first dose of TRUMENBA intramuscular in the left upper at 0.5 ml, single. Relevant medical history included heartburn on an unspecified date in Apr2015 and dermatologic urticarial. Concomitant medications included ZANTAC taken as needed for heartburn. On 29Apr2015, the patient experienced lots and severe pain at the injection site and pain in arm. Patient mentioned that she did not receive any treatment for the adverse events. The patient did not recover from sore arm while she recovered from the pain at the injection site. Follow-up (26Jun2015): Follow-up attempts completed. No further information expected. Follow-up (10Jul2015): New information reported from a contactable consumer includes: updated date of vaccination, medical history, concomitant medication, onset date of the event, outcome. |
|
| VAERS ID: |
598379 (history) |
| Form: |
Version 1.0 |
| Age: |
11.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2015-09-25 |
| Onset: | 2015-09-27 |
| Days after vaccination: | 2 |
| Submitted: |
2015-09-28 |
| Days after onset: | 1 |
| Entered: |
2015-10-02 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. |
FJ2099 / 1 |
NS / IN |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / 1 |
RA / UN |
Administered by: Private Purchased by: Private
Symptoms: Diarrhoea,
Pyrexia,
Viral infection,
Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient developed severe viral like illness with fever, vomiting and diarrhea 48 hours after vaccine. Went to Emergency room for treatment. |
|
| VAERS ID: |
601497 (history) |
| Form: |
Version 1.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2015-09-24 |
| Onset: | 2015-09-25 |
| Days after vaccination: | 1 |
| Submitted: |
2015-09-28 |
| Days after onset: | 3 |
| Entered: |
2015-10-02 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
K014191 / 1 |
RA / UN |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
L13514 / 1 |
LA / UN |
Administered by: Private Purchased by: Public
Symptoms: Cough,
Local reaction,
Myalgia,
Nasal congestion,
Oropharyngeal pain,
Pain in extremity,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient developed severe localized reaction 24 hours after vaccine. C/o fever school called to tell mom child had low grade temp (had HPV and MENACTRA B yesterday), feels somewhat myalgic, says legs hurt and arms hurt too. Denies: nasal congestion, cough, sore throat. |
|
| VAERS ID: |
602443 (history) |
| Form: |
Version 1.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2015-10-02 |
| Onset: | 0000-00-00 |
| Submitted: |
2015-10-05 |
| Entered: |
2015-10-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / UNK |
UN / UN |
Administered by: Unknown Purchased by: Unknown
Symptoms: Loss of consciousness,
Seizure like phenomena
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NYC1500014
Write-up: Patient passed out, had brief generalize seizure like activities, lasted for a few second. Then patient was awake, vital sign stable. No fever, no vomiting, no incontinence. Patient was able to walk home. |
|
| VAERS ID: |
601499 (history) |
| Form: |
Version 1.0 |
| Age: |
11.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2015-09-19 |
| Onset: | 2015-09-21 |
| Days after vaccination: | 2 |
| Submitted: |
2015-09-28 |
| Days after onset: | 7 |
| Entered: |
2015-10-08 |
| Days after submission: | 10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / 1 |
RA / UN |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U5178AA / 1 |
LA / UN |
Administered by: Private Purchased by: Public
Symptoms: Abdominal pain upper,
Constipation,
Headache,
Pyrexia,
Viral infection
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient developed severe viral like illness 48 hours after vaccine. C/O fever 2 days occurred following MENACTRA A and B (mother convinced vaccine related??) 101-102. C/O diarrhea after the MIRALAX last night??? C/O stomach ache very vague but parents gave MIRALAX for constipation. C/O headaches generalized. Denies: nasal congestion, cough, sore throat. |
|
