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This is VAERS ID 1377752

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1377752
VAERS Form:2
Age:50.0
Sex:Male
Location:Washington
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179_H / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Underdose, Syringe 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: None Reported
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: None Reported
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Guest had two failed vaccination attempts with the vaccine running down his left arm and the third vaccination was successful. No indicated treatments for this event at this time. Guest with active ROM. Education on signs and symptoms of infection at the injection sites. No untoward outcomes known at this time.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1377752&WAYBACKHISTORY=ON


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