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This is VAERS ID 1381668

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1381668
VAERS Form:2
Age:16.0
Sex:Female
Location:California
Vaccinated:2021-05-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaemia, Arthralgia, Blood albumin decreased, Blood culture negative, Blood fibrinogen increased, C-reactive protein increased, Culture throat negative, Culture urine negative, Fibrin D dimer increased, Haemoglobin, Joint swelling, Pyrexia, Rash, Sterile pyuria, Urticaria, White blood cell count increased, Peripheral swelling, Complement factor normal, Streptococcus test, Respiratory viral panel, Mycoplasma test negative

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)? Yes
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CRP elevated to 74, elevated D dimer, elevated fibrinogen, anemia from Hgb 14-$g10, albumin 2.7, sterile pyuria 25 WBC, normal complements, ASO titer, negative blood, urine, and throat cultures, negative respiratory panel for 15 pathogens, including mycoplasma (6/6-$g6/8/21 for all testing)
CDC 'Split Type':

Write-up: Fever, urticarial rash to face, neck trunk, and extremities, arthralgias and swelling to hands, feet, ankles, left knee and left elbow occurring 4 weeks after vaccine lasting for 4 days in hospital after 2 days at home. still resolving slowly

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