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From the 10/14/2018 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 616669

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Case Details

VAERS ID: 616669 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2015-08-03
Onset:2015-08-03
   Days after vaccination:0
Submitted: 2015-10-29
   Days after onset:87
Entered: 2015-12-29
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 146101 / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHEH2015US016640

Write-up: Case number PHEH2015US016640, is an initial spontaneous report from a health care professional received on 24 Aug 2015.This report refers to an 18 years old female patient. Medical history and concomitant medications were not reported. She was vaccinated with BEXSERO, (batch number: 146101, expiry date: 30 Apr 2016) into left arm intramuscularly on 03 Aug 2015. On the same day following the vaccination the patient experienced pain and swelling. The outcome, seriousness and causality of the event were not reported.


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