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From the 8/14/2018 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 616350

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Case Details

VAERS ID: 616350 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2015-12-17
Onset:2015-12-17
   Days after vaccination:0
Submitted: 2015-12-19
   Days after onset:2
Entered: 2015-12-23
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13515 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / 2 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of PCOS; Seasonal allergies; Acne
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: (R) upper exterior aspect of the arm red and painful (+3 x5). Developed fever (102.0) and chills on evening of 12/17 per mom.


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