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This is VAERS ID 630336

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 630336
VAERS Form:
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 9/14/2017

VAERS ID: 630336 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 2/14/2018

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 6/14/2018

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 8/14/2018

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 9/14/2018

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 10/14/2018

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 12/24/2020

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 12/30/2020

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 5/7/2021

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.


Changed on 5/21/2021

VAERS ID: 630336 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2016-01-01
Onset:0000-00-00
Submitted:2016-04-04
Entered:2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.

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