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This is VAERS ID 631109

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2016

VAERS ID: 631109
VAERS Form:
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 149001 / - LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - RA / UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Immediate post-injection reaction

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: 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.


Changed on 9/14/2017

VAERS ID: 631109 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 2/14/2018

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 6/14/2018

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 8/14/2018

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 9/14/2018

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 10/14/2018

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 12/24/2020

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 12/30/2020

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 5/7/2021

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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.


Changed on 5/21/2021

VAERS ID: 631109 Before After
VAERS Form:1
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2016-04-04
Onset:2016-04-04
Submitted:2016-04-11
Entered:2016-04-12
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: Syncope, Immediate post-injection reaction

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: 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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