National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 10/15/2021 release of VAERS data:

This is VAERS ID 1696763



Case Details

VAERS ID: 1696763 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nervousness, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt waiting in observation with his mother post #1 Pfizer vaccination, at 9:10am c/o "feeling a lump in throat". No observed SOB or c/o difficulty swallowing. Given Diphenhydramine 50mg at 9:11 am. Hx of anaphylaxis with food only, wheat, nuts. No rash or difficulty breathing, VS 99% room air 110/60 78 12. Pt states feeling nervous due to previous Pt who c/o chest pain post vaccination. Pt observed in clinic until 9:50a and did not have any other symptoms. Advised to contact PCP to report incident. Instructions given to Pt and his mother (by spanish speaking RN) For any further symptoms and implementing 911 if necessary. VSS remained stable, lungs clear, 02 sat 99%. Pt reports he is feeling fine now and ambulated out of clinic with steady gait. States he will rest at home today and his mom will be there.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1696763

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166