VAERS ID: |
902490 (history) |
Form: |
Version 2.0 |
Age: |
37.0 |
Sex: |
Female |
Location: |
New Mexico |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Headache,
Pain SMQs:
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: Benzoyl peroxide 10% gel, Biofreeze topical gel, Cyclobenzaprine 10mg tab, moisturizing cream, naproxen 250 mg tab, ondansetrn 4mg ODT tab, Refresh Tears Current Illness: None Preexisting Conditions: acne, astigmatism, myopia Allergies: NKDA Diagnostic Lab Data: CDC Split Type:
Write-up: Headache, body ache |