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This is VAERS ID 903074

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 903074
VAERS Form:2
Age:29.0
Sex:Male
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Headache

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, famotidine, omeprazole
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache at base of skull near spinal cord 3 hours after dose given


Changed on 12/24/2020

VAERS ID: 903074 Before After
VAERS Form:2
Age:29.0
Sex:Male
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Headache

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, famotidine, omeprazole
Current Illness:
Preexisting Conditions:
Allergies: N/A N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache at base of skull near spinal cord 3 hours after dose given


Changed on 12/30/2020

VAERS ID: 903074 Before After
VAERS Form:2
Age:29.0
Sex:Male
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Headache

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, famotidine, omeprazole
Current Illness:
Preexisting Conditions:
Allergies: N/A N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache at base of skull near spinal cord 3 hours after dose given


Changed on 5/7/2021

VAERS ID: 903074 Before After
VAERS Form:2
Age:29.0
Sex:Male
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Headache

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, famotidine, omeprazole
Current Illness:
Preexisting Conditions:
Allergies: N/A N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache at base of skull near spinal cord 3 hours after dose given


Changed on 5/21/2021

VAERS ID: 903074 Before After
VAERS Form:2
Age:29.0
Sex:Male
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Headache

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, famotidine, omeprazole
Current Illness:
Preexisting Conditions:
Allergies: N/A N/A
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache at base of skull near spinal cord 3 hours after dose given

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