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This is VAERS ID 631144

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 631144
VAERS Form:
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 9/14/2017

VAERS ID: 631144 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 2/14/2018

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 6/14/2018

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 8/14/2018

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 9/14/2018

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 10/14/2018

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 12/24/2020

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 12/30/2020

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 5/7/2021

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.


Changed on 5/21/2021

VAERS ID: 631144 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-04-12
Entered:2016-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Loss of consciousness, 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: Fear of injection, needle phobia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': US2016046390

Write-up: This case was reported by a other health professional via sales rep and described the occurrence of passed out in a 16-year-old female patient who received BEXSERO. Concurrent medical conditions included fear of needles (needle phobia). On an unknown date, the patient received BEXSERO. On an unknown date, immediately after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant). On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to BEXSERO. Additional details were provided as follows: This case was reported by a medical assistant (MA). The sales representative was unable to provide name of the primary reporter. Limited details were known for this report.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=631144&WAYBACKHISTORY=ON


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