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This is VAERS ID 1055003

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1055003
VAERS Form:2
Age:16.0
Sex:Female
Location:Texas
Vaccinated:2021-01-30
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Biopsy skin, Chills, Erythema, Headache, Pruritus, Rash papular, Scab, Skin discolouration, Skin lesion, Swelling

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: prednisone, mercaptopurine, methotrexate, vincristine, trimethoprim-sulfamethoxazole, norethindrone, cholecalciferol, calcium carbonate, famotidine
Current Illness: currently undergoing chemotherapy for B cell acute lymphoblastic leukemia
Preexisting Conditions: B cell acute lymphoblastic leukemia
Allergies: shellfish and platelet blood products
Diagnostic Lab Data: Due to concern for reactivation of varicella zoster/disseminated varicella zoster, she was urgently biopsied by dermatology on 2/25/21 (result pending) and is currently receiving IV acyclovir.
CDC 'Split Type':

Write-up: 1. 48 hours after the first vaccine dose, she developed a raised, red, bump ~4-5cm area on her back with irregular borders. It was slightly itchy but not painful. 2. The area on her back worsened over the next 2-3 weeks and developed dark black scabs. 3. 24 hours after the second vaccine dose (which was given on 2/20/21), she developed scattered lesions on her neck, hairline, ear, face ? some with blisters, some with scabbed tops. Again slightly itchy but not painful. She also had a transient headache and chills that resolved on their own that same day.


Changed on 5/7/2021

VAERS ID: 1055003 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Texas
Vaccinated:2021-01-30
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Biopsy skin, Chills, Erythema, Headache, Pruritus, Rash papular, Scab, Skin discolouration, Skin lesion, Swelling

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: prednisone, mercaptopurine, methotrexate, vincristine, trimethoprim-sulfamethoxazole, norethindrone, cholecalciferol, calcium carbonate, famotidine
Current Illness: currently undergoing chemotherapy for B cell acute lymphoblastic leukemia
Preexisting Conditions: B cell acute lymphoblastic leukemia
Allergies: shellfish and platelet blood products products
Diagnostic Lab Data: Due to concern for reactivation of varicella zoster/disseminated varicella zoster, she was urgently biopsied by dermatology on 2/25/21 (result pending) and is currently receiving IV acyclovir.
CDC 'Split Type':

Write-up: 1. 48 hours after the first vaccine dose, she developed a raised, red, bump ~4-5cm area on her back with irregular borders. It was slightly itchy but not painful. 2. The area on her back worsened over the next 2-3 weeks and developed dark black scabs. 3. 24 hours after the second vaccine dose (which was given on 2/20/21), she developed scattered lesions on her neck, hairline, ear, face ? some with blisters, some with scabbed tops. Again slightly itchy but not painful. She also had a transient headache and chills that resolved on their own that same day.


Changed on 5/14/2021

VAERS ID: 1055003 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Texas
Vaccinated:2021-01-30
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Biopsy skin, Chills, Erythema, Headache, Pruritus, Rash papular, Scab, Skin discolouration, Skin lesion, Swelling

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: prednisone, mercaptopurine, methotrexate, vincristine, trimethoprim-sulfamethoxazole, norethindrone, cholecalciferol, calcium carbonate, famotidine
Current Illness: currently undergoing chemotherapy for B cell acute lymphoblastic leukemia
Preexisting Conditions: B cell acute lymphoblastic leukemia
Allergies: shellfish and platelet blood products products
Diagnostic Lab Data: Due to concern for reactivation of varicella zoster/disseminated varicella zoster, she was urgently biopsied by dermatology on 2/25/21 (result pending) and is currently receiving IV acyclovir.
CDC 'Split Type':

Write-up: 1. 48 hours after the first vaccine dose, she developed a raised, red, bump ~4-5cm area on her back with irregular borders. It was slightly itchy but not painful. 2. The area on her back worsened over the next 2-3 weeks and developed dark black scabs. 3. 24 hours after the second vaccine dose (which was given on 2/20/21), she developed scattered lesions on her neck, hairline, ear, face ? some with blisters, some with scabbed tops. Again slightly itchy but not painful. She also had a transient headache and chills that resolved on their own that same day.

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