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This is VAERS ID 612043

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2015

VAERS ID: 612043
VAERS Form:
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI503AA / 5 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L028082 / 3 RA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose normal, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 9/14/2017

VAERS ID: 612043 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI503AA / 5 6 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L028082 / 3 4 RA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose normal, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 2/14/2018

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 6/14/2018

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 8/14/2018

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 9/14/2018

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 10/14/2018

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 12/24/2020

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 12/30/2020

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 5/7/2021

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb, 16; Glucose, 95
CDC 'Split Type':

Write-up: None stated.


Changed on 5/14/2021

VAERS ID: 612043 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-11-24
Entered:2015-11-25
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, Haemoglobin normal, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=612043&WAYBACKHISTORY=ON


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