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This is VAERS ID 616923

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2016

VAERS ID: 616923
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / - LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 1 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 9/14/2017

VAERS ID: 616923 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / - UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 1 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 2/14/2018

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 6/14/2018

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 8/14/2018

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 9/14/2018

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 10/14/2018

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 12/24/2020

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 12/30/2020

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 5/7/2021

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


Changed on 5/14/2021

VAERS ID: 616923 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2015-12-28
Onset:2015-12-30
Submitted:2015-12-30
Entered:2015-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC 'Split Type':

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=616923&WAYBACKHISTORY=ON

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