| VAERS ID: |
903766 (history) |
| Form: |
Version 2.0 |
| Age: |
36.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Angioedema,
Full blood count,
Human chorionic gonadotropin,
Metabolic function test
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine 100 mcg, albuterol HFA, Wellbutrin XL
Current Illness: None
Preexisting Conditions: CSF leak, migraines, asthma
Allergies: Amoxicillin (hives), divalproex (swelling)
Diagnostic Lab Data: CBC, BMP, HCG
CDC Split Type:
Write-up: Angioedema |
