| VAERS ID: |
902903 (history) |
| Form: |
Version 2.0 |
| Age: |
54.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| 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 |
EK5730 / 1 |
LA / IM |
Administered by: Military Purchased by: ?
Symptoms: Erythema,
Oedema peripheral,
Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives - anthrax, flu unknown brand
Other Medications: Lotrel, Zyrtec, Zoloft, Albuterol and Prilosec
Current Illness: None reported
Preexisting Conditions: Asthma, Hypertension
Allergies: PCN, Lexapro
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Hives within 3 hours lasted 12 hours. Left Arm edema and erythema 24 hours |
