| VAERS ID: |
902810 (history) |
| Form: |
Version 2.0 |
| Age: |
22.0 |
| Sex: |
Female |
| Location: |
Idaho |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anxiety,
Blood pressure increased,
Dizziness,
Dyspnoea,
Injection site pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Altavera .15mg to .3mg PRN Nasonex PRN Proair HFA PRN
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: BP 150/100 (has been high since having COVID in June 2020), HR 150
CDC Split Type:
Write-up: Patient complained of feeling dizzy, anxious, shortness of breath. Did have some pain with injection. Did have mask on while waiting standard 15 minutes. |
