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This is VAERS ID 1693803

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1693803
VAERS Form:2
Age:12.0
Sex:Female
Location:Colorado
Vaccinated:2021-08-25
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain, Swelling, Vaccination site mass

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: No Prescriptions. Patient did receive 2 other vaccines (HPV & Hep A) the same day about 1 hour before Covid 19 Vaccine. One of the vaccines (HPV or Hep A) was in the same arm as the Covid 19 vaccine. Patient takes OTC Vitamins and Antih
Current Illness: None.
Preexisting Conditions: Had childhood Asthma, has outgrown it. Has bad allergies to outdoor things and cats and takes OTC antihistamines for it. No other long-standing health conditions.
Allergies: Patient has allergies to outdoor things (grasses and stuff) and cats, but has never shown allergic reactions to any foods or medications.
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Large Marble-Sized lump at Vaccine site on upper Left Arm. Swelling and painful. No discoloration. Only hurts if pressed on, but even lightly touching site causes mild pain. Gave patient 400 mg OTC ibuprofen for pain and swelling, I will apply ice to her arm as well. I was just informed of the condition and have treated, but have not had time to see results of treatment.

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