| VAERS ID: |
903015 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Male |
| Location: |
Kansas |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| 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 |
EH9899 / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Diarrhoea,
Fatigue,
Injection site reaction,
Migraine,
Muscle fatigue
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Pneumonia vaccine
Other Medications: Vitamin D Multivitamin, Men''s Health, Centrum
Current Illness: No
Preexisting Conditions: Swelling to legs, chronic Was diabetic until one year ago
Allergies: Bleach
Diagnostic Lab Data: no
CDC Split Type:
Write-up: Fatigue, migraine, muscle fatigue on site, diarrhea. |
