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

This is VAERS ID 630014

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Case Details

VAERS ID: 630014 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Virginia  
Vaccinated:2016-03-25
Onset:0000-00-00
Submitted: 2016-03-31
Entered: 2016-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901C / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Anaphylactic reaction, Dyspnoea
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions: Multiple allergies; HPV vaccine, Prophylaxis, 1st dose
Allergies:
Diagnostic Lab Data:
CDC Split Type: US2016041925

Write-up: This case was reported by a physician via sales rep and described the occurrence of anaphylactic reaction in a 13-year-old female patient who received BEXSERO. Previously administered products included HPV vaccine (1st dose). Concurrent medical conditions included multiple allergies. Concomitant products included HPV vaccine. On an unknown date, the patient received BEXSERO. On an unknown date, 10 min after receiving BEXSERO, the patient experienced anaphylactic reaction (serious criteria GSK medically significant) and difficulty breathing. The patient was treated with EPIPEN. On an unknown date, the outcome of the anaphylactic reaction and difficulty breathing were recovered/resolved. The reporter considered the anaphylactic reaction and difficulty breathing to be probably related to BEXSERO. Additional details were received as follows: The reported concomitant dose of HPV vaccine was a subsequent dose of HPV vaccine. The patient did not experience an anaphylactic reaction with first dose of HPV vaccine. The patient was monitored for one hour at vaccination center and then sent home.


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