Vaer Report Details
Age: 41 years old
Gender: Female
State: Indiana
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Type: Coronavirus 2019 vaccine
Manufacturer: PFIZER
Lot: unknown
- Date report was received
- 2022-02-24
- Date form completed
- Date Vaccinated
- 2022-02-22
- Date of Onset
- 1
- Number of days (onset date – vaccination date)
- 1
- Adverse Event Description
-
pain in arm of injection site, stomach cramps, headache, severe fatigue
- Lab Data
-
na
- List of symptoms
-
fatigue headache pain in extremity abdominal pain upper
- Patient Died?
- No
- Date Died
- NA
- Birth defect
- false
- Vaccine Administered By:
- Pharmacy or store
- Vaccine Purchased By:
- Unknown
- Patient visit ER?
- No
- Patient Hospitalized?
- No
- Stay in hospital
- No
- Days in hospital
- Unspecified
- Permanent disability?
- No
- Allergies:
-
na
- Current Illness
-
na