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This is VAERS ID 616350

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2016

VAERS ID: 616350
VAERS Form:
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 0 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 9/14/2017

VAERS ID: 616350 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 0 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 1 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 2/14/2018

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 6/14/2018

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 8/14/2018

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 9/14/2018

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 10/14/2018

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 12/24/2020

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 12/30/2020

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 5/7/2021

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


Changed on 5/14/2021

VAERS ID: 616350 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2015-12-17
Onset:2015-12-17
Submitted:2015-12-19
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=616350&WAYBACKHISTORY=ON

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