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This is VAERS ID 1759269

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759269
VAERS Form:2
Age:95.0
Sex:Female
Location:New York
Vaccinated:2021-10-03
Onset:2021-10-03
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other      Purchased by: ??
Symptoms: Urticaria

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: Taking hydroCHLOROthiazide 25 mg tablet, Sig: 1 tab(s) orally once a day Taking melatonin 3 mg tablet, Sig: 1 tab(s) orally once a day (at bedtime) Taking sertraline 50 mg tablet, Sig: 1 tab(s) orally once a day Taking Singulair 10 mg
Current Illness:
Preexisting Conditions: I48.91 Atrial fibrillation E78.5 Hyperlipidemia I10 Hypertension H40.9 Glaucoma H54.8 Legally blind F39 Mood disorder K21.9 GERD (gastroesophageal reflux disease) G30.9 Alzheimer disease E55.9 Vitamin D deficiency 599.0 UTI (urinary tract infection) N30.00 Acute cystitis without hematuria H90.3 Sensorineural hearing loss (SNHL) of both ears E78.2 Mixed hyperlipidemia K59.00 Constipation G47.00 Insomnia I10 Benign essential hypertension H54.8 Legal blindness
Allergies: N/A
Diagnostic Lab Data: i recommended benadryl. see new order below. i also recommended q15 min safety checks and if any SOB she needs to go to ER. she did not have any SOB or cp at this time but does have rash and itchiness.
CDC 'Split Type':

Write-up: she is having hives on back and legs

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