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This is VAERS ID 1761684

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1761684
VAERS Form:2
Age:67.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-06
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Rhinorrhoea, Respiratory tract congestion, COVID-19

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: acetaminophen 1000mg BID prn for pain aspirin 81mg daily atorvastatin 20mg daily cholecalciferol 1000IU daily duloxetine ferrous sulfate 325mg daily gabapentin 600mg TID multivitamin daily naproxen 500mg BID Fish Oil 1000mg BID pantoprazo
Current Illness: None documented
Preexisting Conditions: Gastro-esophageal reflux disease, impaired glucose tolerance, dyssomnia, daytime somnolence, peripheral neuropathy, onychomycosis
Allergies: Brewer''s yeast - throat swelling mold - throat swelling
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient contracted COVID after being fully vaccinated Runny nose/Congestion

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