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This is VAERS ID 627547

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 627547
VAERS Form:
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / - - / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 2 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 2 RA / IM
TD: TETANUS DIPHTHERIA (TENIVAC) / SANOFI PASTEUR C4736CA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 9/14/2017

VAERS ID: 627547 Before After
VAERS Form:(blank) 1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / - UNK - NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 2 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 1 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 2 3 RA / IM
TD: TETANUS DIPHTHERIA (TENIVAC) / SANOFI PASTEUR C4736CA / 1 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 1/14/2018

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TETANUS DIPHTHERIA (TENIVAC) TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 2/14/2018

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 6/14/2018

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 8/14/2018

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 9/14/2018

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 10/14/2018

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 12/24/2020

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 12/30/2020

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 5/7/2021

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.


Changed on 5/21/2021

VAERS ID: 627547 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:New York
Vaccinated:2016-03-03
Onset:2016-03-05
Submitted:2016-03-07
Entered:2016-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / UNK NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37315 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 3 RA / IM
TD: TD ADSORBED (TENIVAC) / SANOFI PASTEUR C4736CA / 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood bilirubin increased, Jaundice, Splenomegaly

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

Write-up: Pt was seen at ER for jaundice 3/5/16. Pt''s labs showed elevated bili. Enlarged spleen. Pt seen today 3/7/16 in office for reck. and orders given for repeat labs.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=627547&WAYBACKHISTORY=ON


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