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

This is VAERS ID 631109

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Case Details

VAERS ID: 631109 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2016-04-04
Onset:2016-04-04
   Days after vaccination:0
Submitted: 2016-04-11
   Days after onset:7
Entered: 2016-04-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 149001 / UNK LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US2016045645

Write-up: This case was reported by a other health professional via sale rep and described the occurrence of fainting in a 16-year-old male patient who received BEXSERO (batch number 149001, expiry date 1st September 2016). Concomitant products included MENACTRA, On 4th April 2016, the patient received BEXSERO .5 ml. On 4th April 2016, immediately after receiving BEXSERO, the patient experienced fainting. On 4th April 2016, the outcome of the fainting was recovered/resolved. It was unknown if the reporter considered the fainting to be related to BEXSERO. Additional details provided as follows. The healthcare professional reported that, the patient fainted instantly after receiving a dose of BEXSERO vaccine in the left arm once the needle was pulled out. The patient also received the MENACTRA vaccine right before the BEXSERO administration in the right arm. The patient recovered after a few moments.


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