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This is VAERS ID 1376029

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376029
VAERS Form:2
Age:36.0
Sex:Female
Location:Washington
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Immunisation, No adverse event, Needle issue

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:
CDC 'Split Type':

Write-up: Event: Upon administration of the dose, more than half of the dose ran back out of the injection site. Treatment: Following CDC guidelines: Readminister dose in other arm (left deltoid) Patient-reported no side effects or adverse outcomes while on clinic grounds.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376029&WAYBACKHISTORY=ON


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