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

This is VAERS ID 1396452



Case Details

VAERS ID: 1396452 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Oedema, Rash, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: PATIENT REPORTED WITHIN 24 HOURS POST VACCINE HE EXPERIENCED FULL BODY RASH, EDEMA, TACHYCARDIA, AND SHORTNESS OF BREATH. HE SAUGHT EVALUATION FROM THE ED AND WAS THEN DISCHARGED WITH RX FOR TYLENOL. PATIENT STATED STILL FEELING OFF ON 6/14/21 AND I ADVISED HIM TO GO BACK TO THE DOCTOR.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1396452


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