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This is VAERS ID 1415869

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1415869
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET8885 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Fatigue, Pyrexia, Tension headache, SARS-CoV-2 test

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: Comments: N/A Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC 'Split Type': GBPFIZER INC2021657205

Write-up: Tiredness; Headache tension; Fever; This is a spontaneous report from a non-contactable consumer received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106051053055900-NXXMR, Safety Report Unique Identifier GB-MHRA-ADR 25425490. A 31-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: ET8885), via an unspecified route of administration on 03Jun2021 as 1st dose, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. The patient experienced tiredness, headache tension and fever on 04Jun2021. The reporter assessed all events as serious (medically significant). Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: no/negative COVID-19 test on an unspecified date. The outcome of the event tiredness was recovering while the outcome of the events headache tension and fever was recovered on an unspecified date in Jun2021. No follow-up attempts are possible. No further information is expected.

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