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This is VAERS ID 1299353

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1299353
VAERS Form:2
Age:59.0
Sex:Male
Location:New York
Vaccinated:2021-05-01
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest pain

Life Threatening? Yes
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:
CDC 'Split Type': USPFIZER INC2021492372

Write-up: chest pain; This is a spontaneous report from a contactable consumer (patient) reported that a 59-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number was not reported), via an unspecified route of administration, administered in arm left on 01May2021 10:30 (at the age of 59-years-old) as a single dose for covid-19 immunization. The vaccine was administered at the Pharmacy/drug store. The patient''s medical history and concomitant medications were not reported. The next day morning on 02May2021 05:00, the patient experienced chest pain. The event was considered as life-threatening. It was unknown if the patient received treatment for the event. The outcome of the event was unknown. Information on the lot/batch number has been requested.

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