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This is VAERS ID 1804865

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/29/2021

VAERS ID: 1804865
VAERS Form:2
Age:55.0
Sex:Female
Location:New York
Vaccinated:2021-08-03
Onset:2021-08-03
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 pain, Injection site joint pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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 .

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