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This is VAERS ID 1024406

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1024406
VAERS Form:2
Age:86.0
Sex:Female
Location:Washington
Vaccinated:2021-01-21
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies: Ace Inhibitors, paroxetine, sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received the Pfizer covid19 dose 1 on 1/21,2021, subsequently developed diagnoses by Dr. on 2/4/21, left lower extremity, Dr. authorized the second shot and patient received this on 2/11/21

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