National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1771442

Government Disclaimer on use of this data



Case Details

VAERS ID: 1771442 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Fatigue, Imaging procedure, Laboratory test, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Norvasc, Vitamin D3, Melatonin, Omeprazole
Current Illness: Constipation, deconditioning
Preexisting Conditions: HTN, Cardiomyopathy, GERD, Osteoporosis, DM,. IBS
Allergies: Sulfa, Codeine, Gluten, Whey, Lactose
Diagnostic Lab Data: Imaging 10/6, Labs 10/7
CDC Split Type:

Write-up: Fatigue, Myalgia, Shortness of Breath, Fever, Diarrhea


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1771442


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166