VAERS ID: |
903010 (history) |
Form: |
Version 2.0 |
Age: |
|
Sex: |
Male |
Location: |
West Virginia |
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 |
- / 1 |
LA / IM |
Administered by: Work Purchased by: ? Symptoms: Confusional state,
Slow response to stimuli,
Visual impairment SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: yes. Current Illness: UTI Preexisting Conditions: yes Allergies: kna Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58 CDC Split Type:
Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction |