VAERS ID: |
909614 (history) |
Form: |
Version 2.0 |
Age: |
48.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 2020-12-21 |
Onset: | 2020-12-21 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-27 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / SYR |
Administered by: Private Purchased by: ? Symptoms: Heart rate increased,
Hypertension,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)
Life Threatening? Yes
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: Bystolic 5mg Atorvastatin Current Illness: Preexisting Conditions: Allergies: Latex Diagnostic Lab Data: CDC Split Type:
Write-up: Fever, muscle aches, hypertension, rapid heart heart |