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This is VAERS ID 1765518

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First Appeared on 10/8/2021

VAERS ID: 1765518
VAERS Form:2
Age:52.0
Sex:Female
Location:California
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Chills, Injection site erythema, Injection site pain, Pyrexia, Injection site swelling, Extra dose administered, SARS-CoV-2 test negative

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: Fluticasone Propionate daily Rx for my allergy symptoms (runny nose & sneezing); OTC Amberen daily for my hot flushes; Tylenol 500 mg 2x/day since evening of 10/4/21 for booster site pain
Current Illness: Upper respiratory infection 9/15 - 9/17, s/p antibiotics
Preexisting Conditions: Chronic low back pain; on/off hypoglycemia
Allergies: No known allergy
Diagnostic Lab Data: Covid-19 rapid test this morning, 10/6/2021 at 0800 - Negative
CDC 'Split Type':

Write-up: Injection site pain, redness, swelling, chills & low grade fever. (Covid-19 Booster received on Monday, 10/4/2021 at 0850. At night, my right deltoid injection site started to be painful, Tylenol PM 100 mg at 2130 for pain and sleep. The following morning, 10/5/2021, more pain noted on injection site, +swelling and redness to the site, Tylenol 1000 mg taken at 0700 for pain before going to work. In the afternoon 10/5/2021, at around 1430 chills noted. Home by 1700 checked temperature at 1730 = T38.2, Tylenol 1000 mg taken for fever and pain). 10/6/21 morning-No more fever but will with pain, redness and swelling on the right arm/deltoid injection site.

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