National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 611803

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2016

VAERS ID: 611803
VAERS Form:
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 9/14/2017

VAERS ID: 611803 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 2/14/2018

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 6/14/2018

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 8/14/2018

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 9/14/2018

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 10/14/2018

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 12/24/2020

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 12/30/2020

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 5/7/2021

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.


Changed on 5/14/2021

VAERS ID: 611803 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Connecticut
Vaccinated:2015-08-06
Onset:0000-00-00
Submitted:2015-11-11
Entered:2015-11-25
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 pruritus, Pain, Pruritus, Rash erythematous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=611803&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166