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This is VAERS ID 612778

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2015

VAERS ID: 612778
VAERS Form:
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 12/14/2016

VAERS ID: 612778 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 9/14/2017

VAERS ID: 612778 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / - UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 2/14/2018

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 6/14/2018

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 8/14/2018

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 9/14/2018

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 10/14/2018

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 12/24/2020

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 12/30/2020

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 5/7/2021

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.


Changed on 5/14/2021

VAERS ID: 612778 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Nevada
Vaccinated:2015-11-16
Onset:2015-11-16
Submitted:2015-12-01
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Confusional state, Pallor, Speech disorder, Syncope

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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2015400986

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A 12-year-old male patient received, on 16Nov2015, TRUMENBA intramuscular, in the left deltoid, at 0.5 ml, single dose. Relevant medical history was unknown. Concomitant medications included flu vaccine received in the left deltoid and HPV vaccine received in the right deltoid, both on 16Nov2015. The vaccines were administered at the private doctor''s office and was purchased with commercial funds. On 16Nov2015, the patient was pale, had bradycardia, and fainted in office. On the same evening, family reported the patient was confused and was talking gibberish. No hospitalization, emergency room or doctor visit were required. Clinical outcome was unknown at time of this report.

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