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This is VAERS ID 1775182

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775182
VAERS Form:2
Age:72.0
Sex:Female
Location:Tennessee
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hypersensitivity, Pruritus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No
Current Illness: No
Preexisting Conditions: Hypertension
Allergies: No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had a allergic reaction to her 2nd Pfizer vaccine. She experienced ichiness all over her hand, arm, back and stomach.

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