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This is VAERS ID 1462169

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1462169
VAERS Form:2
Age:68.0
Sex:Male
Location:Maine
Vaccinated:2021-06-05
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0187 / 2 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Herpes zoster, Ophthalmic herpes zoster

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: Enalapril Rosuvastatin
Current Illness: None
Preexisting Conditions: High blood pressure Chlorestrol
Allergies: None
Diagnostic Lab Data: 07/08/2021. Office visit to Dr.
CDC 'Split Type':

Write-up: Herpes Zoster ophthalmicus

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