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This is VAERS ID 903417

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 903417
VAERS Form:2
Age:76.0
Sex:Male
Location:Alabama
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Paraesthesia, Pruritus, Paraesthesia oral

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Heart disease Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient began experiencing itching and tingling in lower back and down right leg after leaving the facility (had waited the required 15 minutes). Drove around building and parked and came back in. No rash noted. Vital signs BP 157/73, HR 69, Resp.- 16, O2Sat- 98, Temp- 97. No obvious distress, Alert and Oriented X3. Grips equal and strong, no facial weakness and ambulating without difficulty. After 20 more minutes C/O tingling of lips. Consented to call 911. Assessed by EMS. Vital signs remained stable and patient refused to go to hospital. Called wife to pick him up. Patient required no treatment and left facility at 5:30 pm.


Changed on 12/30/2020

VAERS ID: 903417 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Alabama
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Paraesthesia, Pruritus, Paraesthesia oral

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Heart disease Hypertension
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient began experiencing itching and tingling in lower back and down right leg after leaving the facility (had waited the required 15 minutes). Drove around building and parked and came back in. No rash noted. Vital signs BP 157/73, HR 69, Resp.- 16, O2Sat- 98, Temp- 97. No obvious distress, Alert and Oriented X3. Grips equal and strong, no facial weakness and ambulating without difficulty. After 20 more minutes C/O tingling of lips. Consented to call 911. Assessed by EMS. Vital signs remained stable and patient refused to go to hospital. Called wife to pick him up. Patient required no treatment and left facility at 5:30 pm.


Changed on 5/7/2021

VAERS ID: 903417 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Alabama
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Paraesthesia, Pruritus, Paraesthesia oral

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Heart disease Hypertension
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient began experiencing itching and tingling in lower back and down right leg after leaving the facility (had waited the required 15 minutes). Drove around building and parked and came back in. No rash noted. Vital signs BP 157/73, HR 69, Resp.- 16, O2Sat- 98, Temp- 97. No obvious distress, Alert and Oriented X3. Grips equal and strong, no facial weakness and ambulating without difficulty. After 20 more minutes C/O tingling of lips. Consented to call 911. Assessed by EMS. Vital signs remained stable and patient refused to go to hospital. Called wife to pick him up. Patient required no treatment and left facility at 5:30 pm.


Changed on 5/21/2021

VAERS ID: 903417 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Alabama
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Paraesthesia, Pruritus, Paraesthesia oral

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Heart disease Hypertension
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient began experiencing itching and tingling in lower back and down right leg after leaving the facility (had waited the required 15 minutes). Drove around building and parked and came back in. No rash noted. Vital signs BP 157/73, HR 69, Resp.- 16, O2Sat- 98, Temp- 97. No obvious distress, Alert and Oriented X3. Grips equal and strong, no facial weakness and ambulating without difficulty. After 20 more minutes C/O tingling of lips. Consented to call 911. Assessed by EMS. Vital signs remained stable and patient refused to go to hospital. Called wife to pick him up. Patient required no treatment and left facility at 5:30 pm.

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