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This is VAERS ID 1775511

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775511
VAERS Form:2
Age:76.0
Sex:Female
Location:Ohio
Vaccinated:2021-05-19
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest X-ray normal, Vaccine breakthrough infection, COVID-19, SARS-CoV-2 test positive

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, eliquis, ASA-dipyridamole, atorvastatin, biotin, symbicort, coreg, vit D, clonidine, flexeril, ferrour sulfate, glipizide, hydralazine, insulin glargine, omeprazole, valsartan
Current Illness: no
Preexisting Conditions: severe uncontrolled HTN, CKD4, T2DM, PAD, recurrent unprovoked DVTs, and COPD, DVT, chronic pain
Allergies: clopidogrel, codeine
Diagnostic Lab Data: CXR: clear, PCR + 10.9/2021
CDC 'Split Type':

Write-up: breakthrough covid +, no change in chronic O2 requirements

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