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From the 9/17/2021 release of VAERS data:

This is VAERS ID 612043



Case Details

VAERS ID: 612043 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Nevada  
Vaccinated:2015-11-16
Onset:2015-11-16
   Days after vaccination:0
Submitted: 2015-11-24
   Days after onset:8
Entered: 2015-11-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI503AA / 6 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L028082 / 4 RA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood glucose normal, Drug administered to patient of inappropriate age, Haemoglobin normal
SMQs:, Medication errors (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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC Split Type:

Write-up: None stated.


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