| VAERS ID: |
902823 (history) |
| Form: |
Version 2.0 |
| Age: |
73.0 |
| Sex: |
Male |
| Location: |
West Virginia |
| 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 |
EU9899 / UNK |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (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: Oxybutynin 5mg daily, Eliquis 5mg BID, Prazosin HCL 2mg QHS, Finasteride 5mg QHS, Imdur 15 g day, Zyrtec 10mg QHS, MOM 45ml daily, Klorcon 30mg BID, Lyrica 150mg BID, Lasix 80mg daily and 60mg QPM, UTI Stat 30ml daily, Flonase 50mg BID, Bu
Current Illness:
Preexisting Conditions: DM2, hx of PE, Central Cord Syndrome, Cervical Disc Degeneration
Allergies: Sulfa
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Redness at injection site |
