VAERS ID: |
902815 (history) |
Form: |
Version 2.0 |
Age: |
51.0 |
Sex: |
Male |
Location: |
Arizona |
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 |
EH9899 / 1 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Flushing,
Wheezing SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: None Diagnostic Lab Data: None, patient asymptomatic when he arrived to ER for evaluation. CDC Split Type:
Write-up: Feeling flush and wheezing when walking. |