|
VAERS ID: |
601977 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 2015-09-15 |
Onset: | 2015-10-09 |
Days after vaccination: | 24 |
Submitted: |
2015-10-12 |
Days after onset: | 3 |
Entered: |
2015-10-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
UNKNOWN / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Chest pain,
Fatigue,
Weight decreased SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: None Current Illness: No Preexisting Conditions: No Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt went to ED for fatigue, weight loss, chest pain, and fatigue. Fatigue started about 3 weeks before hospitalization after recieving Bexsero vaccine at doctor''s office. Pt was transferred to another hospital for further work-up. |
|
VAERS ID: |
602498 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 2015-10-07 |
Onset: | 2015-10-08 |
Days after vaccination: | 1 |
Submitted: |
2015-10-08 |
Days after onset: | 0 |
Entered: |
2015-10-12 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / 1 |
RA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site pain SMQs:, Extravasation events (injections, infusions and implants) (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: Had soreness on injection site. No fever |
|
VAERS ID: |
602499 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 2015-10-07 |
Onset: | 2015-10-07 |
Days after vaccination: | 0 |
Submitted: |
2015-10-08 |
Days after onset: | 1 |
Entered: |
2015-10-12 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / 1 |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Erythema,
Headache,
Induration,
Injected limb mobility decreased SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Headache, erythema, induration, inability to lift left arm where injection was given. |
|
VAERS ID: |
603805 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 2015-10-07 |
Onset: | 2015-10-07 |
Days after vaccination: | 0 |
Submitted: |
2015-10-08 |
Days after onset: | 1 |
Entered: |
2015-10-12 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / 1 |
RA / IM |
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
M15032 / 1 |
LA / IM |
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
74NT9 / 1 |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Decreased appetite,
Dizziness,
Erythema,
Headache,
Induration,
Mobility decreased,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Dizziness, headache, decreased appetite, vomiting, inability to move left arm, erythema, induration. |
|
VAERS ID: |
602504 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2015-08-27 |
Onset: | 2015-08-28 |
Days after vaccination: | 1 |
Submitted: |
2015-10-05 |
Days after onset: | 38 |
Entered: |
2015-10-13 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29203 / 1 |
LA / UN |
Administered by: Private Purchased by: Private Symptoms: Erythema,
Eye pain,
Eyelid oedema,
Fatigue,
Nausea,
Pain SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Local redness, pain within 24 hrs. Nausea, fatigue 24 hrs later. Swelling around eyes, pain around eyes - Day 4. |
|
VAERS ID: |
602808 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2015-08-04 |
Onset: | 2015-08-04 |
Days after vaccination: | 0 |
Submitted: |
2015-10-15 |
Days after onset: | 72 |
Entered: |
2015-10-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29203 / UNK |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Headache,
Injection site rash,
Injection site swelling,
Pain SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
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:
Write-up: Headache, body aches, rash and swelling at injection site. |
|
VAERS ID: |
602815 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
Oregon |
Vaccinated: | 2015-08-04 |
Onset: | 2015-08-04 |
Days after vaccination: | 0 |
Submitted: |
2015-10-15 |
Days after onset: | 72 |
Entered: |
2015-10-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29203 / UNK |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Headache,
Injection site rash,
Injection site swelling,
Pain SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
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:
Write-up: Patient reported headache, body aches, rash and swelling at injection site. |
|
VAERS ID: |
602996 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2015-09-15 |
Onset: | 2015-09-16 |
Days after vaccination: | 1 |
Submitted: |
2015-10-07 |
Days after onset: | 21 |
Entered: |
2015-10-16 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
129203 / 1 |
LA / IM |
TDAP: TDAP (ADACEL) / SANOFI PASTEUR |
U5241AA / UNK |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Chills,
Headache,
Injection site swelling,
Injection site warmth,
Pyrexia,
Spinal pain SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: None Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Within 12 hrs of vac. admin - fever $g103+, chills, severe head pain, injection site (right upper arm) warn and swollen. "Jolting" episode in spine 9/16 PM sx clearing and fever down after 36 hrs. |
|
VAERS ID: |
603331 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2015-10-16 |
Entered: |
2015-10-19 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Seizure,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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: 2015344308
Write-up: This is a spontaneous report received from a contactable physician via a Pfizer sales representative. A 18-year-old female patient of an unspecified ethnicity received TRUMENBA, via an unspecified route of administration, on an unspecified date, at single dose. Relevant medical history and concomitant medications were not reported. The patient fainted and convulsed on an unspecified date with outcome of unknown. |
|
VAERS ID: |
604548 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 2015-10-21 |
Onset: | 2015-10-21 |
Days after vaccination: | 0 |
Submitted: |
2015-10-23 |
Days after onset: | 2 |
Entered: |
2015-10-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. |
FJ2235 / 3 |
NS / IN |
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
146101D / 1 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Immediate post-injection reaction,
Injection site bruising,
Injection site pain,
Peripheral swelling SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
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: Ortho-cyclen, multivitamin, vit C, Miralax Current Illness: No Preexisting Conditions: Anxiety Allergies: Diagnostic Lab Data: None CDC Split Type:
Write-up: Severe arm swelling immediately, bruising at injection site the next day, painful to touch. No treatment except Tylenol, warm packs. |
|