VAERS ID: |
903089 (history) |
Form: |
Version 2.0 |
Age: |
40.0 |
Sex: |
Female |
Location: |
Connecticut |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-16 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ? Symptoms: Chills,
Dizziness,
Fatigue,
Flank pain,
Headache,
Myalgia,
Neck pain,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
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: None Current Illness: None Preexisting Conditions: None Allergies: None Diagnostic Lab Data: CDC Split Type:
Write-up: Headache , dizziness, neck pain, left flank pain, fever 100.2 , chills,fatigue and muscle aches. |