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This is VAERS ID 1006474

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1006474
VAERS Form:2
Age:65.0
Sex:Female
Location:North Carolina
Vaccinated:2021-02-01
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Asthenia, Chest X-ray, Chills, Computerised tomogram, Dyspnoea, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, Gabapentin, Januvia, Telmisartan/HCTZ, Eliquis, Glucotrol
Current Illness: None
Preexisting Conditions: Type 2 Diabetes, Hypertension, Past Smoker (quit 2018)
Allergies: Mycin medications (Rash)
Diagnostic Lab Data: CXR: 01 Feb 2021 CT scan: 01 Feb 2021 Labs: 01 Feb 2021
CDC 'Split Type':

Write-up: Within 12 hrs of receiving the vaccine the pt began to experience generalized weakness, chills, shortness of breath with symptoms worsening as time went on. Pt remained afebrile. Pt presented to the ED and was diagnosed with a Pulmonary Embolism.


Changed on 5/7/2021

VAERS ID: 1006474 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:North Carolina
Vaccinated:2021-02-01
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Asthenia, Chest X-ray, Chills, Computerised tomogram, Dyspnoea, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, Gabapentin, Januvia, Telmisartan/HCTZ, Eliquis, Glucotrol
Current Illness: None
Preexisting Conditions: Type 2 Diabetes, Hypertension, Past Smoker (quit 2018)
Allergies: Mycin medications (Rash) (Rash)
Diagnostic Lab Data: CXR: 01 Feb 2021 CT scan: 01 Feb 2021 Labs: 01 Feb 2021
CDC 'Split Type':

Write-up: Within 12 hrs of receiving the vaccine the pt began to experience generalized weakness, chills, shortness of breath with symptoms worsening as time went on. Pt remained afebrile. Pt presented to the ED and was diagnosed with a Pulmonary Embolism.


Changed on 5/21/2021

VAERS ID: 1006474 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:North Carolina
Vaccinated:2021-02-01
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Asthenia, Chest X-ray, Chills, Computerised tomogram, Dyspnoea, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, Gabapentin, Januvia, Telmisartan/HCTZ, Eliquis, Glucotrol
Current Illness: None
Preexisting Conditions: Type 2 Diabetes, Hypertension, Past Smoker (quit 2018)
Allergies: Mycin medications (Rash) (Rash)
Diagnostic Lab Data: CXR: 01 Feb 2021 CT scan: 01 Feb 2021 Labs: 01 Feb 2021
CDC 'Split Type':

Write-up: Within 12 hrs of receiving the vaccine the pt began to experience generalized weakness, chills, shortness of breath with symptoms worsening as time went on. Pt remained afebrile. Pt presented to the ED and was diagnosed with a Pulmonary Embolism.

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