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This is VAERS ID 627564

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 627564
VAERS Form:
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s RT arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 7/14/2016

VAERS ID: 627564 Before After
VAERS Form:
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s RT Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 9/14/2017

VAERS ID: 627564 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 1 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 2/14/2018

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 6/14/2018

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 8/14/2018

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 9/14/2018

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 10/14/2018

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 12/24/2020

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 12/30/2020

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 5/7/2021

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.


Changed on 5/21/2021

VAERS ID: 627564 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Arizona
Vaccinated:2016-02-25
Onset:2016-02-25
Submitted:2016-03-03
Entered:2016-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5155BA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s Rt arm became red, hot to touch, with some swelling, painful when pushed on.

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