VAERS ID: 1753047

AGE: 69| SEX: M|State: LA

Description

Sore arm, malaise, fever, chills lasting 36 hours. Refractory to tylenol. Mild response to ibuprofen.

Symptoms

Chills, Malaise, Pain in extremity, Pyrexia

Vaccines

VAX DATE: 29 September 2021 | ONSET DATE: 29 September 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        01 October 2021
        CAGE_YR:
        69
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        Y
        LAB_DATA:
        V_ADMINBY:
        WRK
        OTHER_MEDS:
        Olmesartan
        CUR_ILL:
        Hypertension
        HISTORY:
        hypertension
        PRIOR_VAX:
        Pfizer Covid Vaccine doses 1 and 2
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        01 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        Sulfa
        V_FUNDBY: