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This is VAERS ID 1783405

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1783405
VAERS Form:2
Age:12.0
Sex:Male
Location:Arizona
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Urticaria

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)? No
Hospitalized? No
Previous Vaccinations: multiple allergens
Other Medications: diphenhydramine, cetirizine, EpiPen, allergy injections
Current Illness: no
Preexisting Conditions: mulitple allergies
Allergies: bees Allergen food panel, cbc w diff, banana, chicken meat, peach, pineapple, mixed nut profile IgE ordered
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: hives approximately 5 min after dose. Treated with diphenhydramine-resolved

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