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This is VAERS ID 902691

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 902691
VAERS Form:2
Age:39.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-14
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020493763

Write-up: Pain; This is a spontaneous report from a non-contactable physician. A 39-year-old male patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), via an unspecified route of administration on 14Dec2020 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Dec2020, the patient experienced pain. The clinical outcome of the pain was unknown. No follow-up attempts are possible; information about lot number cannot be obtained.


Changed on 12/24/2020

VAERS ID: 902691 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-14
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020493763

Write-up: Pain; This is a spontaneous report from a non-contactable physician. A 39-year-old male patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), via an unspecified route of administration on 14Dec2020 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Dec2020, the patient experienced pain. The clinical outcome of the pain was unknown. No follow-up attempts are possible; information about lot number cannot be obtained.


Changed on 12/30/2020

VAERS ID: 902691 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-14
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020493763

Write-up: Pain; This is a spontaneous report from a non-contactable physician. A 39-year-old male patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), via an unspecified route of administration on 14Dec2020 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Dec2020, the patient experienced pain. The clinical outcome of the pain was unknown. No follow-up attempts are possible; information about lot number cannot be obtained.


Changed on 5/7/2021

VAERS ID: 902691 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-14
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020493763

Write-up: Pain; This is a spontaneous report from a non-contactable physician. A 39-year-old male patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), via an unspecified route of administration on 14Dec2020 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Dec2020, the patient experienced pain. The clinical outcome of the pain was unknown. No follow-up attempts are possible; information about lot number cannot be obtained.


Changed on 5/14/2021

VAERS ID: 902691 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-14
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020493763

Write-up: Pain; This is a spontaneous report from a non-contactable physician. A 39-year-old male patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), via an unspecified route of administration on 14Dec2020 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Dec2020, the patient experienced pain. The clinical outcome of the pain was unknown. No follow-up attempts are possible; information about lot number cannot be obtained.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=902691&WAYBACKHISTORY=ON


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