Vaer Report Details
Age: 60 years old
Gender: Male
State: Pennsylvania
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Type: Coronavirus 2019 vaccine
Manufacturer: PFIZER
Lot: fj6369
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2022-01-20
- Date of Onset
- 17
- Number of days (onset date – vaccination date)
- 17
- Adverse Event Description
-
systemic: exhaustion / lethargy-mild, systemic: 20% decrease (shrinkage) of male genitalia-severe
- Lab Data
-
na
- List of symptoms
-
fatigue lethargy genital atrophy
- Patient Died?
- No
- Date Died
- NA
- Birth defect
- false
- Vaccine Administered By:
- Pharmacy or store
- 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
-
na