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VAERS Report 2136996

Case Report Section

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