Adverse Event Report

Field Content
VAERS_ID 1364872
RECVDATE 2021-06-01
STATE NC
AGE_YRS 33
CAGE_YR 33
CAGE_MO
SEX F
RPT_DATE
SYMPTOM_TEXT Knot in arm 2 inches below injection site: 5/28/2021-5/29/2021 pain at injection site: 5/28/2021-5/29/2021 diarrhea: 5/28/2021 throughout the day nausea: 5/28/2021-5/30/2021 intermittently throughout the day extreme fatigue: 5/28/2021-5/31/2021 all day everyday extreme dizziness: 5/28/2021-5/31/2021 intermittently throughout the day; not as much on 5/29/2021, but the worst on 5/30/2021 menthol metallic taste in mouth and throat: 5/28/2021-5/31/2021 intermittently throughout the day slight tingle and swelling of tongue: 5/28/2021 intermittently throughout the day red face: 5/28/2021-5/29/2021 throughout the days whenever walking hot and sweaty then followed by fully body chills: 5/28/2021 intermittently throughout the day chills: 5/28/2021-5/30/2021 intermittently throughout the day
DIED
DATEDIED
L_THREAT
ER_VISIT
HOSPITAL
HOSPDAYS
X_STAY
DISABLE
RECOVD U
VAX_DATE 2021-05-27
ONSET_DATE 2021-05-28
NUMDAYS 1
LAB_DATA Had blood work conducted on 5/30/2021 and white blood count came back within normal range, glucose came back within normal range, pregnancy test came back negative, heart rate slightly increased for patients normal range but overall within the normal range of 120/80 (patients normal range is 90/62). Overall patient in good health with excepts of reported adverse events potentially linked to vaccine.
V_ADMINBY PHM
V_FUNDBY
OTHER_MEDS Loryna (birth control)
CUR_ILL None
HISTORY Thoracic outlet syndrome
PRIOR_VAX
SPLTTYPE
FORM_VERS 2
TODAYS_DATE 2021-06-01
BIRTH_DEFECT
OFC_VISIT Y
ER_ED_VISIT Y
ALLERGIES gluten, nickle, band-aid adhesive, amoxicillin, and oxycodone
SYMPTOMS
  • Blood glucose normal
  • Chills
  • Diarrhoea
  • Dizziness
  • Dysgeusia
  • Erythema
  • Fatigue
  • Feeling hot
  • Heart rate increased
  • Hyperhidrosis
  • Injection site nodule
  • Injection site pain
  • Laboratory test normal
  • Nausea
  • Paraesthesia oral
  • Pregnancy test negative
  • Swollen tongue
  • White blood cell count normal

Vaccines

COVID19 (COVID19 (PFIZER-BIONTECH))
Field Content
VAERS_ID 1364872
VAX_TYPE COVID19
VAX_MANU PFIZER\BIONTECH
VAX_LOT EW0177
VAX_DOSE_SERIES UNK
VAX_ROUTE SYR
VAX_SITE LA
VAX_NAME COVID19 (COVID19 (PFIZER-BIONTECH))
Virtual Assistant