Received Oct 13, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (UNKNOWN)) | UNKNOWN MANUFACTURER | 1 | 8146367 | IM / RA |
Site: Redness at Injection Site-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: Chills-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: rash/redness right upper arm-Mild, Systemic: Weakness-Severe, Additional Details: patient was reporting the adverse reaction symptoms are diminishing as time goes on with/in 24 hrs temp of 103 f, 2 days later temp drop to 101 f. on day 3 she just has the rash about 2-3inch area, Other Vaccines: VaccineTypeBrand: flublok; Manufacturer: sanofi-pasteur; LotNumber: tfaa2543; Route: im; BodySite: right arm; Dose: ; VaxDate: UNKNOWN