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This is VAERS ID 626959

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 626959
VAERS Form:
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 9/14/2017

VAERS ID: 626959 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 1 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 2/14/2018

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 6/14/2018

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 8/14/2018

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 9/14/2018

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 10/14/2018

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 12/24/2020

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 12/30/2020

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 5/7/2021

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.


Changed on 5/21/2021

VAERS ID: 626959 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2016-03-10
Onset:2016-03-10
Submitted:2016-03-11
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Fatigue, Pain in extremity, Vomiting

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: DEPO PROVERA
Current Illness: None
Preexisting Conditions: Mono
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few hours after receiving vaccine, pt c/o extreme arm pain, temp 100.5, abd pain, and vomited 3 times. Woke up next day with fatigue.

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