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This is VAERS ID 1775040

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775040
VAERS Form:2
Age:54.0
Sex:Male
Location:New York
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal discomfort, Abdominal pain lower, Back pain, Constipation, Dizziness, Headache, Hyperhidrosis, Injection site pain, Myalgia, Ear discomfort, Musculoskeletal discomfort, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No known illnesses
Preexisting Conditions: No known long standing health conditions
Allergies: No known allergies
Diagnostic Lab Data: Tests pending
CDC 'Split Type':

Write-up: 10/04/21 @ approximately 10:32 am two minutes or so after injection I started to feel like I was going to faint and I began to get sweaty on my forehead and chest. The pharmacist took my BP at 86/58 after 15 minutes my BP elevated to 93/65. 10/04/21 in pm I began to feel a headache and pressure in my Left ear. 10/05/21 developed soreness in Left arm at injection site approximately 5/10 level of discomfort. 10/06/21 developed pain and discomfort in my Left lateral lower abdominal area and Left lower back area. I developed constipation 10/07/21 symptoms resolved except Left abdominal wall pain

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