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This is VAERS ID 1696763

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696763
VAERS Form:2
Age:17.0
Sex:Male
Location:California
Vaccinated:2021-09-14
Onset:2021-09-14
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
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.

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