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This is VAERS ID 585704

Case Details

VAERS ID: 585704 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2015-07-07
Onset:2015-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2015-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS U4799BA / 2 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 146801 / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Headache, Injection site pain, Pain, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt had headache, bilateral injection site pain in arms and body aches 7/8/15. Pt had syncope episodes 7/9/15 and fever 7/9/15.


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