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This is VAERS ID 903415

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 903415
VAERS Form:2
Age:19.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5130 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dizziness, Hypersensitivity

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: Proair HFA inhaler, Benzoyl Peroxide 10% Gel, Clindamycin 1% Gel, Tretinoin 0.05% Cream
Current Illness: Acne
Preexisting Conditions: Asthma, Allergic Rhinitis
Allergies: NKDA
Diagnostic Lab Data: No labs ordered. Only vitals taken as reported above in Item 18.
CDC 'Split Type':

Write-up: Patient experienced mild alllergic reaction starting at 4:19pm. The ER staff came to tend to the patient. The patient reported dizziness and weakness. Her vitals are as follows: BP 142/80, O2-99% on room air, Pulse-98, Resp Rate-18, Temp-97.3F. The patient was taken to the ER and received Benadryl 50mg IV and an Epipen. The patient''s pain was 0/10. The patient was reported stable at 4:27pm.


Changed on 12/30/2020

VAERS ID: 903415 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5130 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dizziness, Hypersensitivity

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: Proair HFA inhaler, Benzoyl Peroxide 10% Gel, Clindamycin 1% Gel, Tretinoin 0.05% Cream
Current Illness: Acne
Preexisting Conditions: Asthma, Allergic Rhinitis
Allergies: NKDA NKDA
Diagnostic Lab Data: No labs ordered. Only vitals taken as reported above in Item 18.
CDC 'Split Type':

Write-up: Patient experienced mild alllergic reaction starting at 4:19pm. The ER staff came to tend to the patient. The patient reported dizziness and weakness. Her vitals are as follows: BP 142/80, O2-99% on room air, Pulse-98, Resp Rate-18, Temp-97.3F. The patient was taken to the ER and received Benadryl 50mg IV and an Epipen. The patient''s pain was 0/10. The patient was reported stable at 4:27pm.


Changed on 5/7/2021

VAERS ID: 903415 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5130 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dizziness, Hypersensitivity

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: Proair HFA inhaler, Benzoyl Peroxide 10% Gel, Clindamycin 1% Gel, Tretinoin 0.05% Cream
Current Illness: Acne
Preexisting Conditions: Asthma, Allergic Rhinitis
Allergies: NKDA NKDA
Diagnostic Lab Data: No labs ordered. Only vitals taken as reported above in Item 18.
CDC 'Split Type':

Write-up: Patient experienced mild alllergic reaction starting at 4:19pm. The ER staff came to tend to the patient. The patient reported dizziness and weakness. Her vitals are as follows: BP 142/80, O2-99% on room air, Pulse-98, Resp Rate-18, Temp-97.3F. The patient was taken to the ER and received Benadryl 50mg IV and an Epipen. The patient''s pain was 0/10. The patient was reported stable at 4:27pm.


Changed on 5/14/2021

VAERS ID: 903415 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5130 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dizziness, Hypersensitivity

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: Proair HFA inhaler, Benzoyl Peroxide 10% Gel, Clindamycin 1% Gel, Tretinoin 0.05% Cream
Current Illness: Acne
Preexisting Conditions: Asthma, Allergic Rhinitis
Allergies: NKDA NKDA
Diagnostic Lab Data: No labs ordered. Only vitals taken as reported above in Item 18.
CDC 'Split Type':

Write-up: Patient experienced mild alllergic reaction starting at 4:19pm. The ER staff came to tend to the patient. The patient reported dizziness and weakness. Her vitals are as follows: BP 142/80, O2-99% on room air, Pulse-98, Resp Rate-18, Temp-97.3F. The patient was taken to the ER and received Benadryl 50mg IV and an Epipen. The patient''s pain was 0/10. The patient was reported stable at 4:27pm.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=903415&WAYBACKHISTORY=ON

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