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This is VAERS ID 1715802

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1715802
VAERS Form:2
Age:67.0
Sex:Female
Location:Indiana
Vaccinated:2021-09-08
Onset:2021-09-10
Submitted:0000-00-00
Entered:2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F 3184 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: GSK Shingles vaccine-small shingles outbreak within 48 hours. Did not receive the 2nd shingles vaccine as a result. 65 years ol
Other Medications: Pulmacort and multi-vitamin
Current Illness: none
Preexisting Conditions: Reactive Airway Disease
Allergies: Ceclor, Codeine, other narcotics
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Sore arm muscle at injection site for about 3 days

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