VAERS ID: 1382708

AGE: 13| SEX: M|STATE: CT

Description

tachycardia, chest pain, pressure

Symptoms

Blood test, Chest X-ray, Chest discomfort, Chest pain, Electrocardiogram, Tachycardia

Vaccines

VAX DATE: 06-05-2021| ONSET DATE: 06-06-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH EW0177 IM LA

RECVDATE:06-08-2021
RPT_DATE:
CAGE_YR:13
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:6/6/2021: seen in emergency room at hospital, EKG, chest x-ray and blood work completed (all within normal limits).
V_ADMINBY:PHM
OTHER_MEDS:Singular 40mg, Claritin 10mg, Flintstone's vitamins
CUR_ILL:none
HISTORY:asthma
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:06-08-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Environmental, pollen, dust, dogs
V_FUNDBY:

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