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This is VAERS ID 1779695

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1779695
VAERS Form:2
Age:76.0
Sex:Male
Location:New York
Vaccinated:2021-10-05
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 FE3592 / 3 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cough, Headache, Night sweats, Pain, Pyrexia

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: DVT and PE, 2 nights in ER following second Pfizer on March 25, 2021, covid 19 dose
Other Medications: crestor, prozac, naltrexone, singulair, prolia, flonase, calcium/vitamin D
Current Illness: none
Preexisting Conditions: prostate cancer survivor
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: aches and pains, perspiration at night, headache, some coughing, probably fever but never measured all for about 3 days

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