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This is VAERS ID 1371754

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371754
VAERS Form:2
Age:24.0
Sex:Male
Location:Illinois
Vaccinated:2021-05-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: Military      Purchased by: ??
Symptoms: Dyspnoea, Urticaria

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: none
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived on 03JUN2021 to receive 2nd dose of Pfizer. Patient reported that following 1st dose of Pfizer and completing standard observation period of 15min, he developed onset of Hives and SOB 1 hour (10am) following administration of the Pfizer vaccine at 0900. Patient reports that he did not seek medical attention and chose to wait out the symptoms. Patient reported that his SOB resolved 30min following onset without medical intervention. Patient reported that his Hives resolved 2hours following onset without medical intervention. Patient 2nd dose of Pfizer was not given due to potential adverse reaction to 1st dose.

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