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This is VAERS ID 616514

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2016

VAERS ID: 616514
VAERS Form:
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / - - / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / - RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 9/14/2017

VAERS ID: 616514 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / - UNK - NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / - UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / - UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 2/14/2018

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 6/14/2018

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 8/14/2018

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 9/14/2018

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 10/14/2018

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 12/24/2020

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 12/30/2020

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 5/7/2021

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.


Changed on 5/14/2021

VAERS ID: 616514 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2015-12-15
Onset:2015-12-16
Submitted:0000-00-00
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Nodule

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Golf ball size knot with redness.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=616514&WAYBACKHISTORY=ON

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