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This is VAERS ID 903132

History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 903132
VAERS Form:2
Age:40.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Throat tightness, Wheelchair user

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations: Influenza vaccine containing eggs
Other Medications: Amlodipine 2.5 mg daily Hydrochlorothiazide 37.5 mg daily Losartan 50 mg bid Metoprolol 50 mg daily Albuterol inhaler as needed
Current Illness: None
Preexisting Conditions: Hypertension h/o LTBI (treated)
Allergies: Chicken, reaction throat tightness Chocolate, throat tightness Egg, throat tightness Shellfish, rash and throat tightness
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 40 year female received Pfizer-BioNTech COVID-19 Vaccine today Patient reported prior h/o severe allergic reaction to influenza vaccine with eggs preservative. She has received flu vaccine w/o egg w/o problem. Due to her prior history of severe allergic reaction/ anaphylaxis to another vaccine, in this case flu vaccine with eggs, we should proceed with caution. She was told we could defer vaccination until more information becomes available. She opted to proceed with receiving Pfizer-BioNTech COVID-19 Vaccine and be observed for 30 minute observation period. Patient developed throat tightening approximately 20 minutes after vaccination. She received EpiPen within 1 minute of symptoms and was sent to ER immediately in wheelchair by nursing staff. Patient was evaluated in ED and was hemodynamically stable. She was given IV benadryl and was stable throughout observation


Changed on 12/24/2020

VAERS ID: 903132 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Throat tightness, Wheelchair user

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations: Influenza vaccine containing eggs
Other Medications: Amlodipine 2.5 mg daily Hydrochlorothiazide 37.5 mg daily Losartan 50 mg bid Metoprolol 50 mg daily Albuterol inhaler as needed
Current Illness: None
Preexisting Conditions: Hypertension h/o LTBI (treated)
Allergies: Chicken, reaction throat tightness Chocolate, throat tightness Egg, throat tightness Shellfish, rash and throat tightness tightness
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 40 year female received Pfizer-BioNTech COVID-19 Vaccine today Patient reported prior h/o severe allergic reaction to influenza vaccine with eggs preservative. She has received flu vaccine w/o egg w/o problem. Due to her prior history of severe allergic reaction/ anaphylaxis to another vaccine, in this case flu vaccine with eggs, we should proceed with caution. She was told we could defer vaccination until more information becomes available. She opted to proceed with receiving Pfizer-BioNTech COVID-19 Vaccine and be observed for 30 minute observation period. Patient developed throat tightening approximately 20 minutes after vaccination. She received EpiPen within 1 minute of symptoms and was sent to ER immediately in wheelchair by nursing staff. Patient was evaluated in ED and was hemodynamically stable. She was given IV benadryl and was stable throughout observation


Changed on 12/30/2020

VAERS ID: 903132 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Throat tightness, Wheelchair user

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations: Influenza vaccine containing eggs
Other Medications: Amlodipine 2.5 mg daily Hydrochlorothiazide 37.5 mg daily Losartan 50 mg bid Metoprolol 50 mg daily Albuterol inhaler as needed
Current Illness: None
Preexisting Conditions: Hypertension h/o LTBI (treated)
Allergies: Chicken, reaction throat tightness Chocolate, throat tightness Egg, throat tightness Shellfish, rash and throat tightness tightness
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 40 year female received Pfizer-BioNTech COVID-19 Vaccine today Patient reported prior h/o severe allergic reaction to influenza vaccine with eggs preservative. She has received flu vaccine w/o egg w/o problem. Due to her prior history of severe allergic reaction/ anaphylaxis to another vaccine, in this case flu vaccine with eggs, we should proceed with caution. She was told we could defer vaccination until more information becomes available. She opted to proceed with receiving Pfizer-BioNTech COVID-19 Vaccine and be observed for 30 minute observation period. Patient developed throat tightening approximately 20 minutes after vaccination. She received EpiPen within 1 minute of symptoms and was sent to ER immediately in wheelchair by nursing staff. Patient was evaluated in ED and was hemodynamically stable. She was given IV benadryl and was stable throughout observation

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