VAERS ID: |
902997 (history) |
Form: |
Version 2.0 |
Age: |
30.0 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: | 2020-12-16 |
Onset: | 2020-12-17 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Dizziness,
Glassy eyes,
Hyperhidrosis,
Nausea,
Visual tracking test abnormal SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: PANTOPRAZOLE Current Illness: NONE Preexisting Conditions: ASTHMA Allergies: PENICILLIN Diagnostic Lab Data: CDC Split Type:
Write-up: SWEATY, NAUSEA, DIZZY, EYES GLAZED OVER, NOT TRACKING RIGHT, STARTED MORNING AFTER SHOT |