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VAERS ID: | 902758 |
VAERS Form: | 2 |
Age: | 43.0 |
Sex: | Male |
Location: | Alaska |
Vaccinated: | 2020-12-16 |
Onset: | 2020-12-16 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-16 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | LA / IM |
Administered by: Private Purchased by: ??
Symptoms: Abnormal sensation in eye, Dizziness, Dry mouth, Euphoric mood, Periorbital swelling, Blood test
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI- generic brand
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood drawn. un sure of test ordered.
CDC 'Split Type':
Write-up: @ ~5 min felt cotton mouth. Got up to ask if he could go early. Then at 10 min post injection, felt eyes feeling weird and he felt "high". As in lightheaded. @ 10 min, skin surrounding the eyes are puffy. Given 25 mf benedryl. No immediate SOB or wheeze. No lip or mouth or throat swelling. Taken to ED. Given IM epi 1:1000 0.3ml. Pepcid and more benedryll PO.
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