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This is VAERS ID 626961

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2016

VAERS ID: 626961
VAERS Form:
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / - - / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 9/14/2017

VAERS ID: 626961 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / - UNK - NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 2/14/2018

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 6/14/2018

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 8/14/2018

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 9/14/2018

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 10/14/2018

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 12/24/2020

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 12/30/2020

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 5/7/2021

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".


Changed on 5/21/2021

VAERS ID: 626961 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:South Carolina
Vaccinated:2015-11-19
Onset:2015-11-20
Submitted:2015-11-23
Entered:2016-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2145 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS L13515 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain in extremity, Rash, Rash erythematous

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: Vitamin D
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The day after vaccine pt c/o intense arm pain w/red rash spreading down the arm in the shape of an "S".

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