VAERS ID: |
902902 (history) |
Form: |
Version 2.0 |
Age: |
29.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 2020-12-17 |
Onset: | 2020-12-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Dizziness,
Pruritus,
Tachycardia,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: vitamins Current Illness: none Preexisting Conditions: none Allergies: Rocephin Diagnostic Lab Data: none CDC Split Type:
Write-up: Patient presented with feeling of "headrush" dizziness, tachycardia to 130''s, itching to neck, visible hives to face and neck. |