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This is VAERS ID 1777316

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1777316
VAERS Form:2
Age:12.0
Sex:Male
Location:Colorado
Vaccinated:2021-10-01
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Urticaria

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: Insulin
Current Illness: N/A
Preexisting Conditions: Type 1 DM
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: hives on face, started on day 8- persisted x3 days, intermittent, noted mostly on cheeks/forehead, resolve after 30 minutes

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