National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/14/2022 release of VAERS data:

This is VAERS ID 1804865

Government Disclaimer on use of this data



Case Details

VAERS ID: 1804865 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C5787AA / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Injection site joint pain, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desoxyn, Wellbutrin, Lexapro,
Current Illness: Deep toe laceration
Preexisting Conditions: ADHD, depression, anxiety
Allergies: Penicillin, Peanuts, Soy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in upper arm at injection site, shoulder and joint. The pain began almost immediately but I didn?t realize how sever until around 5pm .


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1804865


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166