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This is VAERS ID 1772024

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1772024
VAERS Form:2
Age:57.0
Sex:Female
Location:Louisiana
Vaccinated:2021-09-29
Onset:2021-10-01
Submitted:0000-00-00
Entered:2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 3 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, Injection site pain, Pain, Pyrexia, Extra dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reports that she received COVID Booster on 9/29/2021. States low grade temp (99) for a few days, mild pain at injection site of left deltoid, body aches and headaches for last 3 days. Advised to call PCP for appointment. Patient verbalized understanding.

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