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This is VAERS ID 1778783

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1778783
VAERS Form:2
Age:85.0
Sex:Female
Location:Nebraska
Vaccinated:2021-10-08
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Arthralgia, Fluid retention, Lymph node pain, Pruritus, Rash, Urticaria

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: Tetanus Shot: Localized swelling in the arm Penicillin Shot: Hospitalized
Other Medications: Losartan 100mg (once daily)
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: Penicillin Codeine Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Small rough bumps on right arm, raised whelps that itched and spread through the body, joint aches in legs and arms, sensitivity in lymph nodes in neck, fluid retention underneath both eyes

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