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This is VAERS ID 1330993

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330993
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Erythema, Injection site erythema, Injection site paraesthesia, Rash, Rash macular

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Peanuts, Animal Hair, Grass
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is a 15-year-old, male. Alert, oriented X4, clear speech, able to answer to questions. No known medical history. History of anaphylaxis twice in past, requiring the use of epinephrine. History of allergies to peanuts, animal hair, and grass. At 11:43 am, the patient received his first dose of Pfizer (lot number EW0185, expires on 08/2021) on left deltoid. Patient walked with a steady, balanced gait to EMT observation area. At 12:00 pm, patient''s mother notified EMT that patient had blotchy redness in left hand. Lead RN responded immediately and assessed the patient. Upon observation, the patient had localized redness at the injection site, with erythema on the entirety of his back and hands. Patient was assisted patient to anti-gravity chair. Patient states he feels "tingling" at injection site. Patient denied SOB, itching, and dizziness. Patient remained A&Ox4 and talking to EMT. RN requested vitals Q5 minutes for 30 minutes while she drew up 1.0 mL of IM Benadryl. At 12:02 pm: BP of 108/70, HR 78, SPO2 98%. At 12:08 pm, the redness and rash on patient''s arm and back had completely subsided. Patient denies feeling tingling sensation at injection site. At 12:10 pm: BP of 110/67, HR 75, SPO2 99%. Patient''s mother declined use of IM Benadryl. Lead RN education patient and mother on signs and symptoms of anaphylaxis, and requested the patient stay for an additional 20 minutes for monitoring. RN disposed of 1.0 mL dose of Benadryl. At 12:18 pm: BP of 110/70, HR 79, SPO2 99%. At 12:26 pm: BP of 108/70, HR 82, SPO2 99%. At 12:37 pm: BP of 106/70, HR 85, SPO2 97%. Lead RN provided patient''s mother with education concerning when to call 9-1-1, including worsening of symptoms and trouble breathing. Patient was instructed to follow up with PCP and allergist. At 12:40 pm, patient stood up from chair, denied lightheadedness and dizziness. Patient walked to car with steady, balanced gait. Patient''s mother drove patient home.

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