VAERS ID: 2065589

AGE: 11| SEX: M|STATE: CT

Description

1st dose 11/13, 2nd dose 12/8. On 12/31 we noticed small bald spot on patients head. On 1/25/22 Dr. advised it appears to be alopecia. Patient has no previous history of alopecia. Dr. advised we see a specialist and could not rule out this is a side effect of the vaccine.

Symptoms

Alopecia

Vaccines

VAX DATE: 11-01-2021| ONSET DATE: 12-01-2021| DAYS TO ONSET: 30
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 SYR Unknown
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FK5618 Unknown Unknown

RECVDATE:01-26-2022
RPT_DATE:
CAGE_YR:11
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Dr. visual examination in person. Specialist visit recommended and possible testing and treatment necessary.
V_ADMINBY:OTH
OTHER_MEDS:None
CUR_ILL:No
HISTORY:No
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:01-26-2022
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:APRICOT, POSSIBLE ALLERGY TO TYLENOL
V_FUNDBY:

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