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National Vaccine Information Center Your Health. Your Family. Your Choice. |
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| History of Changes from the VAERS Wayback Machine |
| VAERS ID: | 902895 |
| VAERS Form: | 2 |
| Age: | 50.0 |
| Sex: | Female |
| Location: | North Carolina |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Submitted: | 0000-00-00 |
| Entered: | 2020-12-17 |
| Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | RA / IM |
Administered by: Military Purchased by: ??
Symptoms: Cough, Dry throat, Rash
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine 2017
Other Medications: Flintstone vitamin 1 tab daily Align Probiotic 1 capsule daily Black Elderberry Gummie 1 gummie daily Caltrate Soft Chews for Bone health 1 chew daily Cetirizine 10 mg 1 tab PRN as needed for seasonal allergies
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Vicodin Fentanyl Citalopram One reaction to 2017 flu vaccine
Diagnostic Lab Data: None at this time
CDC 'Split Type':
Write-up: Systemic rash, dry cough (causing cough); 650mg Tylenol every 6; 50mg Benadryl to start then 25 mg every 6, Pepcid 20mg every 12 hours; rash is slowly resolving; throat still very dry with dry cough
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Submitted: | 0000-00-00 |
| Entered: | 2020-12-17 |
| Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | RA / IM |
Administered by: Military Purchased by: ??
Symptoms: Cough, Dry throat, Rash
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine 2017
Other Medications: Flintstone vitamin 1 tab daily Align Probiotic 1 capsule daily Black Elderberry Gummie 1 gummie daily Caltrate Soft Chews for Bone health 1 chew daily Cetirizine 10 mg 1 tab PRN as needed for seasonal allergies
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Vicodin Fentanyl Citalopram One reaction to 2017 flu vaccine
Diagnostic Lab Data: None at this time
CDC 'Split Type': (blank) VSafe
Write-up: Systemic rash, dry cough (causing cough); 650mg Tylenol every 6; 50mg Benadryl to start then 25 mg every 6, Pepcid 20mg every 12 hours; rash is slowly resolving; throat still very dry with dry cough
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Submitted: | 0000-00-00 |
| Entered: | 2020-12-17 |
| Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | RA / IM |
Administered by: Military Purchased by: ??
Symptoms: Cough, Dry throat, Rash
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine 2017
Other Medications: Flintstone vitamin 1 tab daily Align Probiotic 1 capsule daily Black Elderberry Gummie 1 gummie daily Caltrate Soft Chews for Bone health 1 chew daily Cetirizine 10 mg 1 tab PRN as needed for seasonal allergies
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Vicodin Fentanyl Citalopram One reaction to 2017 flu vaccine
Diagnostic Lab Data: None at this time
CDC 'Split Type': VSafe (blank)
Write-up: Systemic rash, dry cough (causing cough); 650mg Tylenol every 6; 50mg Benadryl to start then 25 mg every 6, Pepcid 20mg every 12 hours; rash is slowly resolving; throat still very dry with dry cough
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