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This is VAERS ID 1378806

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378806
VAERS Form:2
Age:15.0
Sex:Female
Location:California
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Injection site erythema, Injection site reaction, Rash erythematous, Rash pruritic, Injection site swelling

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: Supplemental vitamin D
Current Illness: Iron deficiency anemia, low vitamin D
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data: 1920 110/66 73bpm 14 99%
CDC 'Split Type':

Write-up: Patient is a 15 year old female who presents following administration of the second dose of Pfizer COVID19 vaccine in the left deltoid. Patient states that she developed a tender, pruritic, red rash at the site of the injection about 10 minutes following the administration. She relates that she also developed smaller red rashes on the left distal portion of the arm. She states that this did not happen with her first dose of Pfizer vaccine. She states she also feels slightly dizzy, but relates that she only at a grilled cheese for lunch and minimal water intake. She denies a history of anaphylaxis and denies allergies to medications, foods, other vaccines. She affirms a past medical history of low vitamin D (currently treated with supplemental vitamin D gummies) and low iron (untreated). She further relates that she had her tonsils removed about 1 year ago. She denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. Exam (update as needed): GEN: Alert and oriented x 4, NAD. HEAD: NCAT EYES: PERRL, EOMI ENT: Ears normal, Nose normal, OP normal with exception of no tonsils noted, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g PULM: Clear to auscultation bilaterally, no accessory muscle use ABD: Soft, no tenderness. SKIN: Skin warm and dry. 0.5mm ecchymosis noted 2 cm below the AC joint and in the correct anatomical position for IM injection. Roughly 5cm of erythema and edema of the left deltoid injection site. The area is mildly tender to palpation, but nonfluctuant. Two 0.5cm erythematous macules located on the left forearm that are nonfluctuant and nontender to palpation. MSK: FROM, MS 5/5 NEURO: Alert and oriented x 4, CN 2-12 grossly intact, no ataxia, gait steady Clinical Impression/Field Tx: Vaccine site reaction. Vital signs within normal limits. Physical exam otherwise normal. Gave patient 10mg OTC Zyrtec from her personal supply. About 30 minutes following administration, the vaccine site was significantly less erythematous and edematous. Patient did not develop any other symptoms. Patient felt comfortable leaving the site. Advised patient and parent that patient should take 25mg diphenhydramine PO once, once they arrive at home. Instructed patient to consult the patient?s PCP regarding the post-vaccination reaction. Patient instructed to go to emergency department should she develop chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, worsening skin rash, or cramping abdominal pain with nausea/vomiting. Patient and parent demonstrated understanding of post-vaccination instructions. Medications administered: Patient self administered 10mg of Zyrtec. Disposition: Home

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