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This is VAERS ID 1765737

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1765737
VAERS Form:2
Age:62.0
Sex:Female
Location:New York
Vaccinated:2021-10-01
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 FF8841 / 3 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Breast swelling, Lymph node pain, Lymphadenopathy, Tenderness

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: Lisinopril, calcium, vitamin D, biotin
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None. Did report to the relevant department on 10/4/21.
CDC 'Split Type':

Write-up: Visible swelling in left clavicle appears to be fluid filled. Tender, slightly painful. Palpable swelling in left upper breast. This is more diffuse but not visible. Tender.

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