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This is VAERS ID 594644

Case Details

VAERS ID: 594644 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2015-08-19
Onset:2015-08-19
   Days after vaccination:0
Submitted: 2015-08-28
   Days after onset:9
Entered: 2015-09-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13514 / 1 RA / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Paraesthesia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Allergies: PCN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated on 8/19/15. Parent reports redness, swelling on same day. On 8/24/15, walking into clinic, redness spreading down arm patient reporting tingling.


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