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This is VAERS ID 1775757

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775757
VAERS Form:2
Age:68.0
Sex:Female
Location:California
Vaccinated:2021-10-10
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR3592 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Throat tightness

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: FOOD, PENICILLIN
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: PATIENT EXPERIENCED DIFFICULTY BREATHING/THROAT CLOSING UP ABOUT 5 MINUTES AFTER THE VACCINE. GAVE PATIENT ONE DOSE OF 0.3MG EPINEPHRINE AND CALLED EMERGENCY

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