| VAERS ID: |
902842 (history) |
| Form: |
Version 2.0 |
| Age: |
53.0 |
| Sex: |
Female |
| Location: |
Missouri |
| 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 |
EK5730 / 1 |
AR / IM |
Administered by: Work Purchased by: ?
Symptoms: Erythema,
Head discomfort
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: advair, albuterol, azelastine,clotrimazole, duoneb, flonase, meloxicam, metformin, singular, nucala, probiotic, spiriva, Theo-24,
Current Illness:
Preexisting Conditions: Asthma
Allergies: oxycodone,codiene, Nickel, Penicillin, augmentin
Diagnostic Lab Data:
CDC Split Type:
Write-up: Scratching head, redness to hands |
