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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 910053 |
VAERS Form: | 2 |
Age: | 31.0 |
Sex: | Male |
Location: | Idaho |
Vaccinated: | 2020-12-24 |
Onset: | 2020-12-24 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-28 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / 1 | - / IM |
Administered by: Private Purchased by: ??
Symptoms: Dyspnoea, Electrocardiogram, Nausea, Vomiting, Respiratory viral panel, Pharyngeal swelling, SARS-CoV-2 test negative
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amphetamine-dextroamphetamine Zolpidem
Current Illness: Acid Reflux Hiatal Hernia
Preexisting Conditions: Acid Reflux Hiatal Hernia
Allergies: no known
Diagnostic Lab Data: COVID-19 test - negative Respiratory panel - negative CMC EKG
CDC 'Split Type':
Write-up: 15 minute post vaccination observation patient denied any symptoms. Later in the day patient experienced significant nausea and vomiting followed by mild SOB and throat swelling.
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