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This is VAERS ID 1758575

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1758575
VAERS Form:2
Age:60.0
Sex:Male
Location:Texas
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: Migraine Hearing loss hip pain bilateral knee pain hypertension GERD Sleep apnea Fibromyalgia neuropathy
Allergies: Shellfish, peanuts
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Pt had received two Moderna vaccines and I gave the pt Pfizer vaccine as a booster. Pt did not have any adverse events at the time.

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