VAERS ID: |
902894 (history) |
Form: |
Version 2.0 |
Age: |
24.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 2020-12-16 |
Onset: | 2020-12-17 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Hypersensitivity,
Lacrimation increased,
Swelling face,
Throat irritation SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: Denied Current Illness: Preexisting Conditions: Allergies: Prior reaction to "certain animals" Diagnostic Lab Data: None CDC Split Type:
Write-up: Allergic reaction with facial swelling, eye tearing, "itchy" throat |