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From the 1/14/2016 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 616635

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Case Details

VAERS ID: 616635 (history)  
Form: Version .0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2015-06-08
Onset:2015-06-13
   Days after vaccination:5
Submitted: 2015-10-29
   Days after onset:138
Entered: 2015-12-29
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 146101 / - LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions: Food allergy, Many food allergy resolved after several years
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHEH2015US015166

Write-up: Case number PHEH2015US015166, is an initial spontaneous report from a physician received on 23 Jul 2015 with follow up report received from physician on 21 Sep 2015. This report refers to an 18-year-old female patient. Medical history and concomitant medications were not reported. She was vaccinated with BEXSERO (batch number: 146101) at a dose of 0.5 ml intramuscularly into left deltoid on 08 Jun 2015 at 15:30 PM. On an unknown date she had body rash. On 13 Jun 2015, she experienced hives on whole body. Treatment medication included BENADRYL oral. The outcome of hives was reported as complete recovery on 07 Jul 2015. The outcome of body rash was not reported. The seriousness of the events was not reported. Causality was reported as probable. Seriousness of the event hives whole body was upgraded based on available information in the source document. Follow up report received from physician on 21 Sep 2015: Medical history and event hives whole body added. Vaccine batch number, dose and time, age, patient demography updated.


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