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

This is VAERS ID 630222

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Case Details

VAERS ID: 630222 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2016-04-01
Onset:2016-04-01
   Days after vaccination:0
Submitted: 2016-04-01
   Days after onset:0
Entered: 2016-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 149002 / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5259AA / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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:
Current Illness: 12:15
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient receiving MENACTRA and BEXSERO vaccines. MENACTRA administered in the right arm and BEXSERO was administered in the left arm patient fainted hitting the floor. Hitting his head. Was ok and Dr. did exam after.


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