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This is VAERS ID 628703

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 628703
VAERS Form:
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 0 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 0 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 9/14/2017

VAERS ID: 628703 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 0 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 0 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 2/14/2018

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 6/14/2018

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 8/14/2018

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 9/14/2018

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 10/14/2018

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 12/24/2020

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 12/30/2020

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 5/7/2021

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.


Changed on 5/21/2021

VAERS ID: 628703 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:New York
Vaccinated:2016-03-21
Onset:2016-03-21
Submitted:2016-03-23
Entered:2016-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3343R / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 LA / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia

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: Adderall XR 20MG (1 PO daily)
Current Illness: No
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, bodyache, fever, dizzy, headache.

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