VAERS ID: |
902938 (history) |
Form: |
Version 2.0 |
Age: |
55.0 |
Sex: |
Male |
Location: |
Idaho |
Vaccinated: | 2020-12-17 |
Onset: | 2020-12-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
PAA156051 / 1 |
UN / IM |
Administered by: Private Purchased by: ? Symptoms: Flushing,
Paraesthesia,
Throat irritation SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: 0749 - tingling in body, scratchy throat for 10 minutes, flushing |