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This is VAERS ID 1418359

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1418359
VAERS Form:2
Age:12.0
Sex:Male
Location:California
Vaccinated:2021-06-06
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest pain, Cough, Fatigue, Somnolence, Secretion discharge, Oropharyngeal pain

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hx asthma
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received 2nd dose of Pfizer vaccine on 6/6/2021. Patient started to develop symptoms on 6/20/2021. Per Mother, patient developed cough, chest pain, mucus production, throat pain. Reports feeling sleepy and tired. Symptoms seem to be worsening in the last 2 days per report from mother over the phone. Mother advised to have patient be seen by a provider. Mother drove patient to Emergency room while on the phone.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1418359&WAYBACKHISTORY=ON


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