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This is VAERS ID 631558

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

VAERS ID: 631558
VAERS Form:
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 4 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 0 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 9/14/2017

VAERS ID: 631558 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 4 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 0 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 2/14/2018

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 6/14/2018

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 8/14/2018

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 9/14/2018

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 10/14/2018

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 12/24/2020

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 12/30/2020

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 5/7/2021

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.


Changed on 5/21/2021

VAERS ID: 631558 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2016-04-12
Onset:2016-04-12
Submitted:2016-04-14
Entered:2016-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS DF92Z / 5 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Myalgia, Pain, Mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Severe pain began about 1 hour after injection, now (04/14/16) came to clinic due to immobility of arm due to pain of muscles radiating from right chest to elbow per patient. Pain medication prescribed.

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