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This is VAERS ID 1762295

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1762295
VAERS Form:2
Age:47.0
Sex:Male
Location:New Jersey
Vaccinated:2021-03-29
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 - / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Fatigue, Pyrexia, Vaccine breakthrough infection, COVID-19, SARS-CoV-2 test positive

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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 10/3/2021
CDC 'Split Type':

Write-up: Client received Pfizer vaccines for Covid on 3/29 and 4/19/2021. Symptoms started 9/30: chills, fever, fatigue. Tested PCR + for Covid on 10/3. Reported as breakthrough Covid case in a fully vaccinated person

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