National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1758688

Government Disclaimer on use of this data



Case Details

VAERS ID: 1758688 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 292R2 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin (10th day) Fluconazole EpiPen 2-Pk
Current Illness: Strep throat and yeast infection
Preexisting Conditions: None
Allergies: tree nuts and peanuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient present with mother for second dose of covid pfizer vaccine. Patient has allergies to peanuts and tree nuts - was waiting 30 minutes. Vaccine administered at 1054. At 1115 patient called RN over to bedside for itchiness and hives developing on chest. Denies difficulty breathing at this time. Dr. called to bedside and put orders for 5ml of benadryl. 1120 Benadryl administered. Mother decided to stay additional 10 minutes for observation. 1127 patient stated she was having minimal difficulty swallowing her saliva. Denied difficulty breathing at this time. Vital signs were taken with continuous o2 sats. Dr. notified and additional orders placed. Benadryl 37.5mg (15ml) given to patient. Dr. prescribed prednisone 60mg at 1211. Patient took medication in office and observed for 30 additional minutes.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1758688


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