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This is VAERS ID 597865

Case Details

VAERS ID: 597865 (history)  
Form: Version 1.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
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 J29203 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site rash
SMQs:, 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: Topiramate; Vitamin B; Vitamin D
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2015184769

Write-up: This is a spontaneous report from a contactable other HCP, a contactable medical assistant, calling from Doctor''s office and from a contactable Physician. A 26-year old female patient received TRUMENBA (lot # J29203, Exp. Date: JUN2016 via intramuscular route of administration 0.5 ml single dose in MAR2015 at 9:30 AM in left deltoid. The patient did not have any other medical condition. Concomitant medication included TOPIRAMATE 100 mg, VITAMIN B, VITAMIN D, PROBIOTICS. On an unspecified date the patient experienced rash at the injection site over the half of the upper arm: there was kind of an imprint of the rash but could feel redness of the rash but had recovered. The outcome of the events was recovered. The event did not require an emergency room or physician visit. The physician assessed there a reasonable possibility that the event is related to suspect product. Follow up (16JUL2015): New information from a contactable Physician included: vaccine details, reporter''s assessment. Follow up attempts completed. No further information expected.


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