National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/7/2022 release of VAERS data:

This is VAERS ID 627022

Government Disclaimer on use of this data



Case Details

VAERS ID: 627022 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2016-03-14
Onset:2016-03-14
   Days after vaccination:0
Submitted: 2016-03-14
   Days after onset:0
Entered: 2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M13064 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5172AA / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Dyskinesia, Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: None
Current Illness: Rhinitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Approximately 15 min after receiving Menactra and meningococcal B (Trumemba), pt was leaving the clinic area when he fell to the floor and had a brief episode of body jerking. He regained consciousness about 3 min later and was able to state his location and date of birth. EMS arrived and took patient to the Hospital for further evaluation.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=627022


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166