National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

This is VAERS ID 1376359



Case Details

VAERS ID: 1376359 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Itch Generalized-Mild, Systemic: Allergic: Rash Generalized-Mild, Additional Details: MOM CAME IN LESS THAN 24 HOURS TO REPORT THAT PATIENT BROKE OUT IN RASH ON HIS TORSO AT 6PM THE NIGHT ON 5/5/21. HE RECEIVED THE VACCINE ON 6/3/21. THE RASH ALSO SPREAD TO LEGS . HE DID HAVE ITCHING . HE IS GETTING BETTER IN REGARDS TO RASH/ITCHING. I DID RECOMMEND MOM TO GIVE BENADRYL AND FOLLOW UP WITH PROVIDER REGARDING 2ND DOSE


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376359


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166