VAERS ID: 920628

AGE: 63| SEX: F|STATE: NY (United States)

Description

6-7 hours after the vaccine she developed arm pain, fever and chills. About an hour later she started to have abdominal pain which worsened over the course of the day to excruciating. She went to the Emergency Room where a CT scan revealed a perforation of her sigmoid colon and had a resection of the area of the colon and a diverting colostomy surgery done the evening of 1/3/2021.

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Symptoms

Chills, Pyrexia, Abdominal pain, Pain in extremity, Large intestine perforation, Computerised tomogram abnormal, Intestinal resection, Colostomy, Computerised tomogram abdomen

Vaccines

VAX DATE: 01-02-2021| ONSET DATE: 01-02-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EL0142 IM LA

RECVDATE:01-05-2021
RPT_DATE:
CAGE_YR:63
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:CT scan of abdomen and pelvis 1/3/2021
V_ADMINBY:PVT
OTHER_MEDS:Tylenol 350 mg as needed Valium 5 mg as needed
CUR_ILL:
HISTORY:pancreatic cysts colonic polyps last colonoscopy 9/2020 and one polyp removed ATM gene mutation hyperlipidemia DCIS of breast in 1/2015 s/p lumpectomy and xrt thyroid nodules vertigo
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-05-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:Compazine led to restless leg syndrome Penicillin anaphylaxis Sulfamethoxazole rash
V_FUNDBY:

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