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This is VAERS ID 1255597

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1255597
VAERS Form:2
Age:
Sex:Male
Location:Kentucky
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Drug ineffective, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: Covid-19; Test Result: Positive
CDC 'Split Type': USPFIZER INC2021412086

Write-up: Diagnosed (tested positive) with Covid19; Diagnosed (tested positive) with Covid19; This is a spontaneous report from a Pfizer-sponsored program. A contactable consumer (patient) reported that a male patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number and expiration date were not reported) as a single dose, with route of administration and therapy date unspecified, for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On 11Apr2021, after the first dose of vaccination, the patient was diagnosed (tested positive) with COVID-19. The outcome of the event was unknown. The patient was scheduled to receive the second dose of vaccination on 13Apr2021, and was told to put it off. Information about lot/batch number has been requested.


Changed on 5/7/2021

VAERS ID: 1255597 Before After
VAERS Form:2
Age:
Sex:Male
Location:Kentucky
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Drug ineffective, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: Covid-19; Test Result: Positive
CDC 'Split Type': USPFIZER INC2021412086

Write-up: Diagnosed (tested positive) with Covid19; Diagnosed (tested positive) with Covid19; This is a spontaneous report from a Pfizer-sponsored program. A contactable consumer (patient) reported that a male patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number and expiration date were not reported) as a single dose, with route of administration and therapy date unspecified, for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On 11Apr2021, after the first dose of vaccination, the patient was diagnosed (tested positive) with COVID-19. The outcome of the event was unknown. The patient was scheduled to receive the second dose of vaccination on 13Apr2021, and was told to put it off. Information about lot/batch number has been requested.


Changed on 5/14/2021

VAERS ID: 1255597 Before After
VAERS Form:2
Age:
Sex:Male
Location:Kentucky
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Drug ineffective, COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: Covid-19; Test Result: Positive
CDC 'Split Type': USPFIZER INC2021412086

Write-up: Diagnosed (tested positive) with Covid19; Diagnosed (tested positive) with Covid19; This is a spontaneous report from a Pfizer-sponsored program. A contactable consumer (patient) reported that a male patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number and expiration date were not reported) as a single dose, with route of administration and therapy date unspecified, for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On 11Apr2021, after the first dose of vaccination, the patient was diagnosed (tested positive) with COVID-19. The outcome of the event was unknown. The patient was scheduled to receive the second dose of vaccination on 13Apr2021, and was told to put it off. Information about lot/batch number has been requested.

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