| VAERS ID: |
909778 (history) |
| Form: |
Version 2.0 |
| Age: |
20.0 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Dysphagia,
Electroencephalogram,
Pruritus,
Psychogenic seizure,
Swollen tongue,
Tongue pruritus,
Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Depovera
Current Illness:
Preexisting Conditions: Asthma
Allergies: Morphine, penicillin, Shellfish, iodine, honey, pollen, dust
Diagnostic Lab Data: EEG
CDC Split Type:
Write-up: 8:27 Hives, itching all over chest and on tongue, tongue swelling, slight difficulty swallowing. 8:30 epi administered/ benedrly 8:32 pseudo seizures begin off and on till the 27th |
