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This is VAERS ID 630222

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

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

Administered by: Private      Purchased by: Private
Symptoms: Head injury, Syncope

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:
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.


Changed on 9/14/2017

VAERS ID: 630222 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 2/14/2018

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 6/14/2018

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 8/14/2018

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 9/14/2018

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 10/14/2018

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 12/24/2020

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 12/30/2020

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 5/7/2021

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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.


Changed on 5/21/2021

VAERS ID: 630222 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Pennsylvania
Vaccinated:2016-04-01
Onset:2016-04-01
Submitted:2016-04-01
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

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:
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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