VAERS ID: 1799343

AGE: 13| SEX: F|STATE: WI (United States)

Description

Interstitial lung disease, Dyspnea, decreased oxygen saturation, generalized fatigue. Unchanged at over 8 weeks post vaccine. Prognosis unknown.

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Symptoms

Dyspnoea, Interstitial lung disease, Fatigue, Chest X-ray abnormal, Oxygen saturation decreased, Pulmonary function test abnormal, Computerised tomogram thorax abnormal, Scan with contrast abnormal

Vaccines

VAX DATE: 08-21-2021| ONSET DATE: 09-03-2021| DAYS TO ONSET: 13
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FC3182 IM RA

RECVDATE:10-19-2021
RPT_DATE:
CAGE_YR:13
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:Y
RECOVD:N
LAB_DATA:CXR, PFTs, & CT contrast chest (10/2021) all confirm interstitial lung disease post COVID vaccine
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-19-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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