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This is VAERS ID 1779216

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1779216
VAERS Form:2
Age:78.0
Sex:Male
Location:Maryland
Vaccinated:2021-09-07
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NDC:59267-1000- / UNK RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Erythema, Pruritus, Rash maculo-papular, 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: Lisinopril 10/12.5 mg daily Atorvastatin 10 mg daily Omega 3 CoEnzyme Q Ca with Vit D3
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Severe maculo papular rash on the body; itchy; pinkish with wheel formation. Will clear after taking Claritin 10 mg initially but will reappear. Now Taking Allegra 180 mg in am and Claritin 24 Hr. in PM daily for at least one week. Rash disappears only to reappear a few hours later and then goes away again.

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