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VAERS Report 2157442

Case Report Section

Vaer Report Details

Age: 8 years old

Gender: Male

State: Unknown

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fn4072


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-03
Date of Onset
60
Number of days (onset date – vaccination date)
60
Adverse Event Description

urticaria, rash

Lab Data
na
List of symptoms
rash urticaria
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Private
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
acute stomach flu 15 days before