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This is VAERS ID 603805

Case Details

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.


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