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This is VAERS ID 1753355

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1753355
VAERS Form:2
Age:88.0
Sex:Female
Location:New York
Vaccinated:2021-09-28
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Erythema, Lethargy, Photophobia, Pruritus, Skin warm, Swelling

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: Colace 100 mg 1 tab daily at bedtime Atorvastatin 10 mg 1 tab at bedtime Levothyroxine 75 mcg 1 tab q am MONTELUKAST 10 mg 1 tab by mouth daily Albuterol sulfate 90 mcg 2 puffs every 4 hours as needed Triamterene/hydrochl 37.5-25 m
Current Illness: NA
Preexisting Conditions: Hypertension, history of kidney stones, bronchitis/asthma, cervical spine stenosis
Allergies: : Colophony Bacitracin Chlorhexidine adhesive tape pine nuts and cinnamon
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Left upper shoulder redness, warmth, swelling and itchiness. Complains of lethargy and sensitivity to light.

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