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VAERS ID: 1714996

AGE: 15| SEX: M|State: WV

Description

Red itchy rash on torso, groin, inner elbows on both arm, back of knee on both legs, fingers, chin line, along neck/chin line. Large (approximate circumference of 1-1/2 size of a silver dollarraised lump with blister ring surrounding lump on front side of ankle

Symptoms

Blister, Limb mass, Rash, Rash erythematous, Rash pruritic

Vaccines

VAX DATE: 14 September 2021 | ONSET DATE: 15 September 2021 | DAYS TO ONSET: 1
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • SYR
  • RA
  • FC3183

RECVDATE:19 September 2021
CAGE_YR:15
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:Visual exam given by urgent care 9/20/2021 at approximately 9am
V_ADMINBY:PHM
OTHER_MEDS:None
CUR_ILL:None
HISTORY:None
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:19 September 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:None
V_FUNDBY:
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