Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH||EW0150 / 1||RA / IM|
Administered by: Other Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: Cardiac Med (Unknown by patient)
Current Illness: Cardiac
Preexisting Conditions: Cardiac
Diagnostic Lab Data: NA
CDC 'Split Type':
Write-up: This is for documentation only. Patient stated she received her 1st dose of Pfizer on May 13th, 2021. Confirmed by her daughter. However, the state reporting system says she got Johnson and Johnson. Patient received dose of Pfizer today. No apparent adverse reaction at this time. Patient was held for 30 minutes. No problems. Patient did not bring her vaccination card to appointment
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