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This is VAERS ID 919148

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 919148
VAERS Form:2
Age:59.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Facial paralysis, Paraesthesia

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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: penicillins
Diagnostic Lab Data: 1/4/21 at 0200 - BP 169/96 mmHg, HR 72 bpm, O2 sats 99%
CDC 'Split Type':

Write-up: Patient received his vaccine and waited the 15 minute observation period before leaving the clinic. At 2:00 he returned to the clinic, stating to the paramedic that he felt like he was having an episode of Bell''s Palsy. His vital signs were checked and were as follows: BP 169/96 mmHg, HR 72 bpm, O2 sat 99%. The patient has right sided tingling extending from the eye to the mouth. He had no visual changes. The patient was offered transport to the hospital and further medical treatment. He refused transport or treatment and left the vaccination clinic.


Changed on 5/7/2021

VAERS ID: 919148 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Facial paralysis, Paraesthesia

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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: penicillins penicillins
Diagnostic Lab Data: 1/4/21 at 0200 - BP 169/96 mmHg, HR 72 bpm, O2 sats 99%
CDC 'Split Type':

Write-up: Patient received his vaccine and waited the 15 minute observation period before leaving the clinic. At 2:00 he returned to the clinic, stating to the paramedic that he felt like he was having an episode of Bell''s Palsy. His vital signs were checked and were as follows: BP 169/96 mmHg, HR 72 bpm, O2 sat 99%. The patient has right sided tingling extending from the eye to the mouth. He had no visual changes. The patient was offered transport to the hospital and further medical treatment. He refused transport or treatment and left the vaccination clinic.


Changed on 5/14/2021

VAERS ID: 919148 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Facial paralysis, Paraesthesia

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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: penicillins penicillins
Diagnostic Lab Data: 1/4/21 at 0200 - BP 169/96 mmHg, HR 72 bpm, O2 sats 99%
CDC 'Split Type':

Write-up: Patient received his vaccine and waited the 15 minute observation period before leaving the clinic. At 2:00 he returned to the clinic, stating to the paramedic that he felt like he was having an episode of Bell''s Palsy. His vital signs were checked and were as follows: BP 169/96 mmHg, HR 72 bpm, O2 sat 99%. The patient has right sided tingling extending from the eye to the mouth. He had no visual changes. The patient was offered transport to the hospital and further medical treatment. He refused transport or treatment and left the vaccination clinic.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=919148&WAYBACKHISTORY=ON


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