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This is VAERS ID 1775714

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775714
VAERS Form:2
Age:63.0
Sex:Female
Location:Tennessee
Vaccinated:2021-10-08
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Extra dose administered, Mouth swelling

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: Bendadryl (10/10), Atenolol, Prempro, Lisinorpil, Atorvastatin
Current Illness: N/A
Preexisting Conditions: Asthma, Hypertension
Allergies: N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient complains of left inner mouth swelling approximately two days after receiving her booster COVID vaccine.

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