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This is VAERS ID 602996

Case Details

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.


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