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This is VAERS ID 903010

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 903010
VAERS Form:2
Age:
Sex:Male
Location:West Virginia
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Confusional state, Slow response to stimuli, Visual impairment

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC 'Split Type':

Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction


Changed on 12/24/2020

VAERS ID: 903010 Before After
VAERS Form:2
Age:
Sex:Male
Location:West Virginia
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Confusional state, Slow response to stimuli, Visual impairment

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC 'Split Type':

Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction


Changed on 12/30/2020

VAERS ID: 903010 Before After
VAERS Form:2
Age:
Sex:Male
Location:West Virginia
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Confusional state, Slow response to stimuli, Visual impairment

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC 'Split Type':

Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction


Changed on 5/7/2021

VAERS ID: 903010 Before After
VAERS Form:2
Age:
Sex:Male
Location:West Virginia
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Confusional state, Slow response to stimuli, Visual impairment

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC 'Split Type':

Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction


Changed on 5/21/2021

VAERS ID: 903010 Before After
VAERS Form:2
Age:
Sex:Male
Location:West Virginia
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Confusional state, Slow response to stimuli, Visual impairment

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC 'Split Type':

Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction

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