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This is VAERS ID 902655

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 902655
VAERS Form:2
Age:28.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chills, Headache, Pain

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: chills - 0730 body ache, headache - 1000 headache significantly worse - 1110


Changed on 12/24/2020

VAERS ID: 902655 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chills, Headache, Pain

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: chills - 0730 body ache, headache - 1000 headache significantly worse - 1110


Changed on 12/30/2020

VAERS ID: 902655 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chills, Headache, Pain

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: chills - 0730 body ache, headache - 1000 headache significantly worse - 1110


Changed on 5/7/2021

VAERS ID: 902655 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chills, Headache, Pain

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: chills - 0730 body ache, headache - 1000 headache significantly worse - 1110


Changed on 5/14/2021

VAERS ID: 902655 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chills, Headache, Pain

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: chills - 0730 body ache, headache - 1000 headache significantly worse - 1110

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