VAERS ID: |
902768 (history) |
Form: |
Version 2.0 |
Age: |
42.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 2020-12-16 |
Onset: | 2020-12-16 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Heart rate decreased,
Nausea,
Tremor SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Ciprofloxacin-rash Pregablin-insomnia Diagnostic Lab Data: CDC Split Type:
Write-up: Nausea, tremors, and decrease in HR. Patient taken to ED. No epinephrine injection administered. |