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From the 11/19/2021 release of VAERS data:

This is VAERS ID 625925

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Case Details

VAERS ID: 625925 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2015-12-09
Onset:2015-12-09
   Days after vaccination:0
Submitted: 2016-02-18
   Days after onset:71
Entered: 2016-02-26
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J28923 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Disturbance in attention, Fatigue, Influenza virus test negative, Injection site erythema, Injection site swelling, Lethargy, Malaise, Pain, Vaccination site pain, Vaccination site warmth
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLONASE
Current Illness:
Preexisting Conditions: Seasonal allergy
Allergies:
Diagnostic Lab Data: 12/10/2015, Influenza virus test, Negative
CDC Split Type: 2015456144

Write-up: This is a spontaneous report from a contactable nurse practitioner via a company representative and from a healthcare professional on behalf of physician. A 17-year-old male patient received the first dose of TRUMENBA (lot number J28923, expiry date 30Jun2016) at 0.5 ml single, intramuscular, in left arm, on 09Dec2015 at 02:42 P.M. No other vaccine given along with the vaccine. Medical history included seasonal allergies. Concomitant medication included FLONASE daily (25 days), for 2 years. On 09Dec2015, the patient experienced achiness and extreme fatigue, raised area of redness around the injection site, 4x5 cm red/hot/tender area at vaccination site, that persisted for 48 hours with hot to touch and general lethargy. All these events recovered on 11Dec2015, Additionally it was reported that the patient did not feel on 09Dec2015 after noon but had to go back to school and then presented back at the office the next day. He could not concentrate to stay in school. On 10Dec2015 4x5 cm red/hot/tender area at vaccination site, extreme fatigue, body aches and weakness were noted. Outcome of feeling unwell, impaired concentration and vaccination site tenderness was unknown. On 10Dec2015 the patient had a flu test that resulted negative. The reporter felt that there was a causal relationship between the immunization and the reported side effects. Therapeutic measures included TYLENOL. The patient was not admitted to hospital. Follow-up (10Feb2016): New information from a contactable healthcare professional and nurse on behalf of physician includes: vaccination details, medical history, concomitant drug, additional events with relative details.


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