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This is VAERS ID 1696316

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696316
VAERS Form:2
Age:25.0
Sex:Female
Location:Illinois
Vaccinated:2021-09-10
Onset:2021-09-10
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, Heart rate increased, Pyrexia, Exposure during pregnancy, Product preparation error

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Pepcid ASA Folic acid Vit D 5000 units Prenatal Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data: Patient works for Dr., her PCP and he checked on her. She also let OB aware. She is going to have check up with OB this week - Did not go to ER. She did had headache about 6 PM pm 9/10/21. Still has lingering headache.Reports heart rate was 115-120 even resting Saturday and Sunday. Reports her heart rate has gone down now. Had a fever on Saturday - Temp 101.2
CDC 'Split Type':

Write-up: G4P0 EDC 11/21/2021 Hx of IVF Patient went to pharmacy for Pfizer dose #2. At 1:42 PM patient states that pharmacy called her to tell her Pfizer was reconstituted with Moderna Vaccine instead of sodium chloride.

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