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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 902948 |
VAERS Form: | 2 |
Age: | 44.0 |
Sex: | Male |
Location: | Oklahoma |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-17 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | RA / IM |
Administered by: Private Purchased by: ??
Symptoms: Rash pustular
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? No
Previous Vaccinations:
Other Medications: Metformin 500mg bid Irbesartan 150mg qd Depo-testosterone 200mg IM 2qwks
Current Illness: None
Preexisting Conditions: Diabetes mellitus, type 2 Hypertension
Allergies: Tramadol
Diagnostic Lab Data: none
CDC 'Split Type': IHS
Write-up: Papular, pustular rash on back occurring approximately 6-10 hours after injection of vaccine.
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-17 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | RA / IM |
Administered by: Private Purchased by: ??
Symptoms: Rash pustular
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? No
Previous Vaccinations:
Other Medications: Metformin 500mg bid Irbesartan 150mg qd Depo-testosterone 200mg IM 2qwks
Current Illness: None
Preexisting Conditions: Diabetes mellitus, type 2 Hypertension
Allergies: Tramadol
Diagnostic Lab Data: none
CDC 'Split Type': IHS (blank)
Write-up: Papular, pustular rash on back occurring approximately 6-10 hours after injection of vaccine.
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