National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 616717

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2016

VAERS ID: 616717
VAERS Form:
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 9/14/2017

VAERS ID: 616717 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 2/14/2018

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 6/14/2018

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 8/14/2018

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 9/14/2018

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 10/14/2018

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 12/24/2020

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 12/30/2020

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 5/7/2021

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.


Changed on 5/14/2021

VAERS ID: 616717 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2015-12-15
Onset:0000-00-00
Submitted:2015-12-28
Entered:2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site swelling, Injection site nodule

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: Unknown
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2015180415

Write-up: This case was reported by a nurse via sales rep and described the occurrence of injection site swelling in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included penicillin allergy. On 15th December 2015, the patient received BEXSERO .5 ml. In December 2015, less than a week after receiving BEXSERO, the patient experienced injection site swelling. On an unknown date, the outcome of the injection site swelling was unknown. It was unknown if the reporter considered the injection site swelling to be related to BEXSERO. Additional details were received as follows: In December 2015, less than a week (it was unsure whether injection site swelling occurred on same day of vaccination or next day) after receiving BEXSERO the patient experienced severe swelling at the injection site of the size of a baseball (swelled up into a knot) fro about 5 days and was still ongoing at the time of reporting. The patient was allergic to penicillin but did not have any latex allergy. The patient initials, date of birth, vaccine batch number and expiry date of vaccine were unknown. The call was escalated to medical information system.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=616717&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166