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This is VAERS ID 1463916

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1463916
VAERS Form:2
Age:13.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-06-02
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood thyroid stimulating hormone, Hypothyroidism, Thyroxine decreased, Tri-iodothyronine normal, Thyroxine free decreased, Anti-thyroid antibody negative, Anti-thyroid antibody

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dextro-amphetamine ER fluoxetine
Current Illness:
Preexisting Conditions: ADHD, autism
Allergies:
Diagnostic Lab Data: TSH 415, T4 <0.3, free T4 <0.1, T3 41, free T3 134, anti thyroglobulin Ab (-), anti thyroidperoxidase Ab (-)
CDC 'Split Type':

Write-up: patient presented with profound hypothyroidism within weeks of second COVID vaccine

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1463916&WAYBACKHISTORY=ON


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