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This is VAERS ID 630770

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 630770
VAERS Form:
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / - RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 2/14/2017

VAERS ID: 630770 Before After
VAERS Form:
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - UI276AA / - LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - J29203 / - RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - U5026CA / - RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 9/14/2017

VAERS ID: 630770 Before After
VAERS Form:(blank) 1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / - UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / - UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / - UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 2/14/2018

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 6/14/2018

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 8/14/2018

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 9/14/2018

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 10/14/2018

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 12/24/2020

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 12/30/2020

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 5/7/2021

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.


Changed on 5/21/2021

VAERS ID: 630770 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:California
Vaccinated:2016-01-28
Onset:2016-01-29
Submitted:2016-04-08
Entered:2016-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI276AA / UNK LA / SYR
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29203 / UNK RA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5026CA / UNK RA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / SYR

Administered by: Military      Purchased by: Military
Symptoms: Anion gap decreased, Blood albumin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Chills, Haematocrit normal, Haemoglobin normal, Heart rate increased, Injection site erythema, Leukocytosis, Pain, Platelet count decreased, Pyrexia, Red blood cell count normal, Rhinorrhoea, White blood cell count increased, Blood phosphorus decreased, Systemic inflammatory response syndrome, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, HCTZ, Singulair, Flonase, Coumadin, Magnesium
Current Illness: No
Preexisting Conditions: ITP, post-splenectomy (1989, accessory splenule removed in 2011); Factor V Leiden; Hx of multiple thrombi (at least 3); Hyperlipidemia; Allergies to wheat, barley and dust mites
Allergies:
Diagnostic Lab Data: 30 Jan 2016, CBC: WBC 22.5 (H)x10(3)/mcL (4.5-11.0) RBC 5.30(H) x10(6)/mcL (3.8-5.2) Hemoglobin 14.4 g/dL (12.0-16.0) Platelets 73(L)x10(3)/mcL (150-400) 30 Jan 2016, Chem 11 Calcium 8.8 (L)mg/dL (8.9-10.3) Phosphate 2.5 mg/dL (2.5-4.6) Albumin 3.8 g/dL (3.5-5.0) Magnesium 1.8 mg/dL (1.8-2.5) Glucose 111 (H)mg/dL (74-106) Urea Nitrogen 10 mg/dL (8-26) Creatinine 0.7 mg/dL (0.6-1.1) Sodium 135 (L)mmol/L (136-145) Chloride 100 mmol/L (98-107)Potassium 3.4 (L)mmol/L (3.5-5.1)Carbon Dioxide 27 mmol/L (22-32) Anion Gap 11.4 mmol/L (10-20) 01 Mar 2016, CBC WBC 10.6 (H)x10(3)/mcL (4.0-10.5) RBC 5.38(H)x10(6)/mcL 3.9-5.0) Hemoglobin 15.0 g/dL (12.0-15.3) Hematocrit 45.2 % (36.0-46.0)Platelets 111(L)x10(3)/mcL (150-450)
CDC 'Split Type':

Write-up: 51 year-old F with multiple medical problems. Received PPSV23, Hib, MCV4P, and MenB vaccines on 28 Jan 2016. Received Hib and PPV23 in left upper arm, and received both meningococcal vaccines in right upper arm. Within 12 hours of vaccine receipt, patient noted reaction at vaccination site; initially, redness, warmth, swelling and tenderness about 2" in diameter in left upper arm, then rapidly increased over the next 24 hours. No streaking or lymphadenopathy. Patient also felt feverish on 29 Jan and her temperatures were initially around 101. She began self-treating with Tylenol and intermittent ice packs to left upper arm. By 30 Jan (post-vaccination day 2), patient''s site reaction extended from left shoulder almost to elbow and affected area was about 2/3 circumferential around area of injections. Her temperatures peaked at 103.3 and she was shivering vigorously. She also noted her heart beat was rapid, but denies palpitations. Patient denies n/v, headaches, or dyspnea; she had minor body aches. During this time, she had a runny nose, which was responsive to treatment with antihistamines. She sought evaluation on morning of 30 January at Emergency Department. Initial vital signs: T 102.5, BP 132/77, HR 113, RR 18. She was treated with IV fluids and Tylenol. Her lab work was significant for leukocytosis. She was released after approximately 2 1/2 hours of ED check in. Diagnosis: presume fever/leukocytosis secondary to vaccine administration, vital signs and lab consistent with SIRS. Patient was discharged on Tylenol as needed, not to exceed 2 grams daily. Complete resolution of symptoms within 48 hours of ER evaluation.

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