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This is VAERS ID 597873

(NOTE: This result is from the 1/14/2016 version of the VAERS database)

Case Details

VAERS ID: 597873 (history)  
Form: Version .0  
Sex: Female  
Location: Kansas  
   Days after vaccination:0
Submitted: 2015-08-13
   Days after onset:42
Entered: 2015-09-21
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Pain

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: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2015228034

Write-up: This is a spontaneous report obtained from a contactable nurse through a sales representative. This nurse reported about two different children. This is the second of two reports. A female child of an unspecified age and ethnicity received on 02JUL2015 at 11:29, TRUMENBA; (Lot J29203; Ex 30JUN2016) 0.5 ml at single dose, IM (intramuscularly), on the right UOQ in upper leg. Relevant medical history and concomitant medications were unknown. On an 02JUL2015, the patient experienced extreme pain. Clinical outcome of the event was recovered on 06JUL2015. Follow-up (11AUG2015): New information received from the same contactable nurse includes: product data, reaction data and outcome.

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