National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 616923

Government Disclaimer on use of this data



Case Details

VAERS ID: 616923 (history)  
Form: Version .0  
Age: 17.0  
Sex: Female  
Location: Kansas  
Vaccinated:2015-12-28
Onset:2015-12-30
   Days after vaccination:2
Submitted: 2015-12-30
   Days after onset:0
Entered: 2015-12-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI516AA / - LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J29757 / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Erythema multiforme, Pruritus, Rash generalised
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)

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: Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examination by pediatrician
CDC Split Type:

Write-up: Erythema multiforme - onset of rash on feet on 12/30; progreesed to cover entire body as afternoon progressed, pruritis. Prednisone taper prescribed.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20160114&IDNUMBER=616923


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166