VAERS ID: 912698

AGE: 69| SEX: F|STATE: NJ (United States)

Description

Patient received the vaccine on 12/23. Patient reports fever and fatigue from 12/24 ? 12/27 and developed hives on 12/26 and a diffuse red rash on 12/28. Patient was treated in the ED 12/28. On 12/28/20 patient was diagnosed with Diverticulitis, Allergic Reaction. Patient discharged with antibiotics and corticosteroid.

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Symptoms

Pyrexia, Urticaria, Hypersensitivity, Fatigue, Rash erythematous, Diverticulitis, Computerised tomogram abdomen abnormal

Vaccines

VAX DATE: 12-23-2020| ONSET DATE: 12-24-2020| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EK5730 IM UN

RECVDATE:12-29-2020
RPT_DATE:
CAGE_YR:69
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:12/28/20 @0926 CT abdomen: findings POSITIVE for acute sigmoid diverticulitis
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-29-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:Penicillins: swelling Latex: rash
V_FUNDBY:

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